Abstract
Objective
To investigate the correlations among persistent viral infection, heart function and Chinese medicine (CM) difined-syndromes in patients with dilated cardiomyopathy (DCM).
Methods
Fifty patients with DCM in the First Affiliated Hospital of Zhejiang Chinese Medical University from October 2009 to December 2011 were selected as the research subjects, and 30 healthy people were simultaneously selected as the normal control group to detect persistent viral infections after admission. The CM syndrome type and grade of heart function were then evaluated. The expression level of Coxsackie adenovirus receptor (CAR) was detected using the flow cytometry (FCM) technique, coxsackie virus RNA (CVB-RNA) using reverse transcription polymerase chain reaction (RTPCR), and the plasma brain natriuretic peptide (BNP) level with a Triage meter plus diagnosis instrument. Finally, the parameters such as left ventricular end diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were measured by ultrasonic cardiogram. Person correlation analysis was used for measured data, Spearman correlation analysis for rating data, and the Chi-square test for numerical data.
Results
CVB-RNA was positive in 22 patients (44%) with DCM, while only 6 cases (20%) were CVB-RNA-positive in the normal control group, with a significant difference between the two groups (P<0.01). The expression level of CAR was significantly elevated in the DCM group compared with the normal control group (P<0.01). In CVB-RNA-positive patients (22 cases), the expression level of CAR was significantly higher than in CVB-RNA-negative patients (28 cases; P<0.01). In the DCM patients, there was a positive correlation between the CAR expression and the BNP level (r=0.34, P<0.05), while no significant difference was found between the CAR expression and the LVEF and LVEDd (r=−0.32, 0.30, P>0.05). There was no clear correlation between virus infection and the CM syndrome types in DCM patients (r=−0.22, P>0.05). According to the sequence of syndrome types: phlegm → qi deficiency → blood stasis → hydroretention with asthenic yang (from low to high), a positive correlation was existed between the BNP levels and CM syndrome types (r=0.139, P<0.05).
Conclusion
The expression of CAR on the surface of white cells could be used to detect persistent viral infection. The expression level of CAR and heart function in DCM patients were highly correlated. The expression level of BNP may serve as an objective index for differentiating CM syndromes for patients with DCM.
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References
Liu PP, Mason JW. Advances in the understanding of myocarditis. Circulation 2001;104:1076–1082.
Nishtala K, Phong TQ, Steil L, Sauter M, Salazar MG, Kandolf R, et al. Virus-induced dilated cardiomyopathy is characterized by increased levels of fibrotic extracellular matrix proteins and reduced amounts of energy-producing enzymes. Proteomics 2011;11:4310–4320.
Fujioka S, Kitaura Y, Terasaki F. Etiology and quantitative evaluation of viral infection in the myocardium of patients with end-stage idiopathic dilated cardiomyopathy. J Mol Cell Cardiol 2008;45:S33.
Feuer R, Mena I, Pagarigan R, Slifka MK, Whitton JL. Cell cycle status affects coxsackievirus replication, persistence and reaction in vitro. J Vurol 2002;76:4430–4440.
Leuschner F, Katus HA, Kaya Z. Autoimmune myocarditis: past, present and future. J Autoimm 2009;33:282–289.
Archard LC, Bowles NE, Cunningham L, Freeke CA, Olsen EG, Rose ML, et al. Molecular probes for detection of persisting enterovirus infection of human heart and their prognostic value. Eur Heart J 1991;12(Suppl D):56–59.
Liao YH, Yang YZ, Wang ZH. Dilated cardiomyopathy. Chin J Cardiol (Chin) 2007;35:5–9.
Chinese Integrative Medicine Research Deficiency and Geriatrics Professional Committee. CM deficiency syndrome reference standard. Chin J Tradit West Med (Chin) 1986;6:598.
Chinese Integrative Medicine Research of Activating Blood Circulation to Dissipate Blood Stasis Profession Committee. Stasis syndrome diagnostic criteria. Chin J Tradit West Med (Chin) 1987;7:129.
Claude B, Plum F. Cecil textbook of medicine. 20th ed. St. Louis MO: W.B. Saunders Company; 1996:211–231.
Ling W, Shen Q, Wang J, Xu YL, Xu Y. Experimental study of the immuno-PCR assay Coxsackie virus group B antigen. J Sec Milit Med Univ (Chin) 2001;22:264–266.
Chen SX, Xie LS, Mei SW, Qian FR, Chen MF. The significance of Coxsackie virus B RNA and antibody detection in the diagnosis of viral myocarditis. Chin J Labor Med (Chin) 2003;26:166–168.
Ye CH, Cheng ZQ. Experimental study on granzyme B expression in mouse with viral myocarditis. Chin J Microbiol Immunol (Chin) 2009;29:1019–1024.
Yu XH, Li SJ, Tang GH, Li H, Peng HL. Coxsackie adenovirus receptor’s expression and significance of viral dilated cardiomyopathy in peripheral white blood cell. Clin Focus (Chin) 2005;20:9–11.
Sergeeva IA, Christoffels VM. Regulation of expression of atrial and brain natriuretic peptide, biomarkers for heart development and disease. Biochim Biophys Acta 2013;1832:2403–2013.
Mukoyama M, Nakao K, Saito Y, Ogawa Y, Hosoda K, Suga S, et al. Increased human brain natriuretic peptide in congestive heart failure. N Engl J Med 1990;323:757–758.
Mccullough PA, Omland T, Maisel AS. B-type natriuretic peptides: a diagnostic breakthrough for clinicians. Rev Cardiovasc Med 2003;4:72–80.
Wang RP, Duan SS, Ma FF, Lv ZX, Zhang M, Hou X, et al. The clinical observation of integrative medicine treats 45 cases of dilated cardiomyopathy. China J Tradit Chin Med Pharm (Chin) 2004;19:59–60.
Xu YL, Li FY. Clinical observation of the healthy heart particle treatment of dilated cardiomyopathy. Study J Tradit Chin Med (Chin) 2004;22:2326–2327.
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Supported by the Chinese Medicine Project of Zhejiang Province, China (No.2007CB144)
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Liu, Q., Su, Xj., Yu, Y. et al. Correlations among persistent viral infection, heart function and Chinese medicine syndromes in dilated cardiomyopathy patients. Chin. J. Integr. Med. 20, 928–933 (2014). https://doi.org/10.1007/s11655-014-1880-9
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DOI: https://doi.org/10.1007/s11655-014-1880-9