Alla François, Kearney-Schwartz Anna, Radauceanu Anca, Das Dores Sylvie, Dousset Brigitte, Zannad Faiez
Epidemiology Department (EA 3444), University Hospital, Nancy, France.
Eur J Heart Fail. 2006 Mar;8(2):147-53. doi: 10.1016/j.ejheart.2005.06.008. Epub 2005 Sep 29.
Extracellular matrix (ECM) turnover is a major determinant of diastolic dysfunction and pumping capacity, thus potentially contributing to the progression of congestive heart failure (CHF). Patients with both arterial hypertension and diabetes have a high risk of heart failure. Whether these patients have changes in cardiac ECM has not been studied previously. Our objective was to compare blood markers of collagen turnover among patients with CHF, patients with hypertension and type II diabetes (HD), and healthy individuals.
Measurements were performed in 239 CHF patients; 64 HD patients and 92 healthy subjects. We showed by adjusted ANOVA that PIIINP levels were significantly higher in CHF and HD patients than in controls, and higher in CHF patients than in HD patients. MMP1 levels were significantly lower in CHF and HD patients than in controls. Collagen type I markers (PICP and PINP) were not influenced by CHF but were lower in HD patients as compared to controls (p<0.05 for all comparisons).
In heart failure, markers of cardiac collagen synthesis are increased and markers of degradation are decreased, potentially contributing to cardiac fibrosis and thus to poor outcome. Changes in collagen turnover may also occur early in the disease process in high-risk patients before heart failure is clinically detectable.
细胞外基质（ECM）周转是舒张功能障碍和泵血能力的主要决定因素，因此可能促进充血性心力衰竭（CHF）的进展。同时患有动脉高血压和糖尿病的患者心力衰竭风险很高。此前尚未研究过这些患者的心脏ECM是否有变化。我们的目的是比较CHF患者、高血压合并II型糖尿病（HD）患者和健康个体之间胶原周转的血液标志物。
对239例CHF患者、64例HD患者和92例健康受试者进行了测量。我们通过校正后的方差分析表明，CHF患者和HD患者的血清III型前胶原氨基端肽（PIIINP）水平显著高于对照组，且CHF患者高于HD患者。CHF患者和HD患者的基质金属蛋白酶1（MMP1）水平显著低于对照组。I型胶原标志物（前胶原I羧基端前肽（PICP）和前胶原I氨基端前肽（PINP））不受CHF影响，但HD患者低于对照组（所有比较p<0.05）。
在心力衰竭中，心脏胶原合成标志物增加而降解标志物减少，这可能导致心脏纤维化，进而导致不良预后。在心力衰竭临床可检测之前，高危患者在疾病过程早期也可能发生胶原周转变化。
