Peptide In Patients Research Articles

The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

Background: Atrial natriuretic peptide (ANP) is a well-known prognostic marker of outcome and mortality in patients with cardiovascular disease. Midregional proatrial natriuretic peptide (MR-proANP) is a stable fragment of the ANP precursor hormone. As a prognostic marker after ischemic stroke, it reliably predicts poststroke mortality and functional outcome. This study aimed to analyze the prognostic value of MR-proANP in patients with hemorrhagic stroke, i.e. subarachnoid (SAH) and intracerebral hemorrhage (ICH). Methods: MR-proANP was analyzed in patients with spontaneous SAH or spontaneous ICH. All patients were prospectively randomized into two treatment arms: (1) a prophylactic normothermia group with a target core temperature 36.5°C using endovascular cooling, and (2) a control group with conventional stepwise predefined fever management using antipyretic medication and surface cooling. Blood samples were obtained on admission and on days 4 and 7. Measurement of MR-proANP was performed in serum using sandwich immunoassay. The primary endpoint was functional outcome [assessed by the Glasgow Outcome Score (GOS)] and the secondary endpoints were mortality within 180 days after hemorrhagic stroke and influence of temperature on MR-proANP. A favorable outcome was defined as GOS 4-5, and the patients were considered to have a poor outcome with a 180-day GOS score between 1 and 3. Results: Analysis of MR-proANP was performed in 24 patients with spontaneous SAH and 22 patients with spontaneous ICH. MR-proANP was elevated on days 4 and 7 as compared to baseline levels (p < 0.05 and p < 0.001, respectively). High MR-proANP levels (>120 pmol/l) were associated with increased mortality and poor outcome (after 180 days; p < 0.05, respectively). There was no significant difference regarding MR-proANP serum concentrations between the endovascular and the control groups. Conclusions: Increased levels of MR-proANP are independently associated with poor functional outcome and increased mortality after 180 days in patients with hemorrhagic stroke. Endovascular temperature control had no significant influence on MR-proANP levels.

The severity of coronary artery disease and reversible ischemia revealed by N-terminal pro-brain natriuretic peptide in patients with unstable angina and preserved left ventricular function

The association between the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the severity of coronary artery disease (CAD) diagnosed by coronary angiography and other approaches has been investigated. The clinical application of NT-proBNP is restricted by the drawbacks of these techniques now available in screening out patients who need intensive or conservative treatment. Fractional flow reserve (FFR) is superior to coronary angiography and other functional indicators. Accordingly, we designed to investigate the association between NT-proBNP and myocardial ischemia from the perspective of anatomy and physiology in patients with unstable angina and preserved left ventricular function. Plasma samples were collected from 110 patients and NT-proBNP levels were measured by radioimmunoassay. The severity of coronary artery stenosis in patients was measured by coronary angiography and FFR. Stenosis ≥50% in the left main artery or stenosis of 70%, and fractional flow reserve (FFR) ≤0.80 in one or more coronary branches with diameter ≥2mm were defined as “positive”, which require revascularization. NT-proBNP levels increased progressively between patients with negative and positive angiographic results (p<0.05), and between FFR-negative and FFR-positive patients (p<0.05). A significant correlation was observed between logNT-proBNP and logGS (GS=Gensini score, p<0.001). NT-proBNP level serves as a predictor of positive results of angiographic stenosis and FFR, with the area under the receiver operating characteristic curve being 0.697 and 0.787, respectively. NT-proBNP levels are correlated with the severity of anatomic coronary obstruction and inducible myocardial ischemia, but NT-proBNP per se is insufficient to identify clinically significant angiographic and physiological stenoses.

Marked elevation of B-type natriuretic peptide in patients with heart failure and preserved ejection fraction.

Marked elevations of B-type natriuretic peptide (BNP) are not generally seen in patients with heart failure and preserved ejection fraction (HFpEF). The objective of this study was to examine the clinical and laboratory characteristics of a large cohort of patients with HFpEF and markedly elevated BNP. A retrospective examination of 421 inpatients at a university hospital admitted with a diagnosis of HFpEF was performed. Clinical and echocardiographic data in 4 groups of patients with levels of BNP ≤ 100 pg/mL, 100–400 pg/mL, 400–1,000 pg/mL and > 1,000 pg/mL were compared. Patients with HFpEF and BNP > 1,000 pg/mL (28% of the population) were characterized by impaired renal function and greater use of anti-hypertensive medications. A subset of these patients with BNP > 1,000 pg/mL had normal renal function (21%) and were significantly older, more frequently female, and tended to have lower ejection fractions. Conversely, patients with HFpEF and BNP ≤ 100 pg/mL were younger and had preserved renal function. BNP was inversely related to the likelihood of subsequent admission for heart failure, but not to myocardial infarction or death. In conclusion: BNP > 1,000 pg/mL is seen in almost 1/3 of patients hospitalized with HFpEF. This elevation of BNP often reflects impaired renal function, but can also be seen in patients with preserved renal function but relatively impaired systolic function.

The effects of wenxin keli on left ventricular ejection fraction and brain natriuretic Peptide in patients with heart failure: a meta-analysis of randomized controlled trials.

Objective. To evaluate the beneficial and adverse effects of Wenxin Keli (WXKL), either alone or in combination with Western medicine, on the left ventricular ejection fraction (LVEF) and plasma brain natriuretic peptide (BNP) in the treatment of heart failure (HF). Methods. Seven major electronic databases were searched to retrieve potential randomized controlled trials (RCTs) designed to evaluate the clinical effectiveness of WXKL, either alone or in combination with Western medicine, for HF, with the LVEF or BNP after eight weeks of treatment as main outcome measures. The methodological quality of the included studies was assessed using criteria from the Cochrane Handbook for Systematic Review of Interventions, Version 5.1.0, and analyzed using RevMan 5.1.0 software. Results. Eleven RCTs of WXKL were included. The methodological quality of the trials was generally evaluated as low. The risk of bias was high. The results of the meta-analysis showed that WXKL, either alone or in combination with Western medicine, was more effective in LVEF and BNP, compared with no medicine or Western medicine alone, in patients with HF or HF complicated by other diseases. Five of the trials reported adverse events, while the others did not mention them, indicating that the safety of WXKL remains uncertain. Conclusions. WXKL, either alone or in combination with Western medicine, appears to be more effective in improving the LVEF and BNP in patients with HF and HF complications.

Level changes of adiponectin and cd146 in serum in type 2 diabetic nephropathy

Objective: The aim was to observe the level changes of adiponectin (ADPN) and CD146 in serum and clarify the properties of these peptides in patients with type 2 diabetic nephropathy (DN). Materials and Methods: Seventy-five patients with type 2 diabetes and 13 control subjects included in this study. Levels of ADPN and CD146 in serum were measured by enzyme-linked immunosorbent assay. Results: The serum level of ADPN was higher in patients with diabetes than that in controls, and it increased significantly in the DN1 group. The serum level of CD146 was considerably higher in the DN1 group than that in the other groups. The serum level of ADPN was positively correlated with the serum level of CD146 and body mass index in diabetics. The serum level of ADPN in 54 patients with diabetes and vascular atherosclerosis was significantly lower than that in 21 patients without vascular atherosclerosis. However, there was a definite relationship between the serum levels of ADPN and CD146. Conclusion: The serum levels of ADPN and CD146 appear to increase in patients with early DN and decrease in the final stage of DN. Serum ADPN and CD146 may protect against vascular endothelial dysfunction and mitigate endothelial dysfunction in DN. Further study is required to elucidate the exact role of ADPN and CD146 in the progression of vascular complication in DN.

Phase I clinical trial of peptide vaccination with URLC10 and VEGFR1 epitope peptides in patients with advanced gastric cancer

Peptide vaccine treatment has attracted attention in recent years as a new therapy option for chemotherapy-resistant, advanced, unresectable cancer. The safety of peptide vaccination with HLA-A*2402-restricted URLC10-A24-177 and VEGFR1-A12-9 1084 epitope peptides (fixed 2-mg dose) was investigated in a phase I clinical trial of patients with advanced gastric cancer who were refractory to chemotherapy. We determined the HLA genotype of the subjects after enrollment, results of which were held by the evaluation committee and kept from both patients and investigators until completion of the study. The primary end-point was safety of the peptide vaccination. The secondary end-points were immunological responses and clinical outcome, which were compared between the HLA-A*2402-positive and HLA-A*2402-negative groups. The peptides were subcutaneously administered on day 1, 8, 15 and 22 within a 28-day treatment cycle. A total of 14 patients was enrolled in this study; 12 of the 14 patients received 4 or more vaccinations (at least 1 course). No patient had a severe treatment-related adverse event. Findings from evaluation of clinical responses after a single course showed that 4 cases had stable disease and 8 cases had progressive disease. The median overall survival time (MST) for the 12 patients was 3.9 months. The MSTs in the HLA-A*2402-positive and HLA-A*2402-negative groups were, 4.2 and 3.6 months (p= 0.9164), respectively. The results of this study showed that vaccination with URLC10 and VEGFR1 peptides was a safe treatment for advanced gastric cancer. This trial was registered with University Hospital Medical Information Network (UMIN, no. 000002409).

Increased seroreactivity to HERV-K10 peptides in patients with HTLV myelopathy

BackgroundPreviously, we had shown that persons infected with human T-cell lymphoma leukemia virus 1 or 2 (HTLV-1 or 2) had an increased prevalence of antibodies to a peptide in the Pol protein of the retrovirus HERV-K10, homologous to a peptide in HTLV gp21 envelope protein. The prevalence rate was higher in those with myelopathy vs. non-myelopathy. We have now extended our observations to a cohort restricted to North America in whom the diagnosis of HTLV myelopathy was rigorously confirmed to also test for reactivity to another HERV-K10 peptide homologous to the HTLV p24 Gag protein.MethodsSera from 100 volunteer blood donors (VBD), 53 patients with large granular lymphocytic leukemia (LGLL), 74 subjects with HTLV-1 or 2 infection (58 non-myelopathy and 16 myelopathy) and 83 patients with multiple sclerosis (MS) were evaluated in ELISA assays using the above peptides.ResultsThe HTLV myelopathy patients had a statistically significant increased prevalence of antibodies to both HERV-K10 peptides (87.5%) vs. the VBD (0%), LGLL patients (0%), MS patients (4.8%), and the HTLV positive non-myelopathy subjects (5.2%).ConclusionThe data suggest that immuno-cross-reactivity to HERV-K10 peptides and/or transactivation of HERV-K10 expression by the HTLV Tax protein may be involved in the pathogenesis of HTLV-associated myelopathy/tropical spastic paraparesis and spastic ataxia.

Reduced skin reactivity to vasoconstrictor and vasodilator substances in atopic eczema

Atopic eczema is a common chronic inflammatory disease with itchy skin and altered skin reactions to acetylcholine and nicotinic acid compared to healthy non-atopic individuals. The aim of this study was to evaluate skin reactivity to 11 vasoactive substances and peptides by skin prick and intradermal tests in 20 patients with atopic eczema and 20 healthy controls. Skin reactions, blanching, wheal and flare areas were measured by planimetry, 15 minutes after provocation. Patients with atopic eczema had significantly smaller reactions at certain concentrations of the vasodilators acetylcholine, bradykinin, calcitonin gene-related peptide, substance P and vasoactive intestinal peptide for flare, and of substance P and vasoactive intestinal peptide for wheals, in intradermal testing and/or in skin prick testing. Testing of the vasoconstrictors angiotensin-II, arginine-vasopressin, endothelin-1 and noradrenaline in atopic eczema resulted in significantly smaller reactions at certain concentrations for blanching in intradermal testing and/or skin prick testing. Significantly smaller reactions were seen with arginine-vasopressin for wheals and with arginine-vasopressin and noradrenaline for flares in intradermal testing and/or skin prick testing at certain concentrations. Significantly larger wheals were seen with angiotensin-II and endothelin-1 in intradermal testing and/or skin prick testing at certain concentrations. No significant differences were found for prostaglandin E2. These results demonstrate not only a reduced responsiveness to vasodilators but also to vasoconstrictor substances and peptides in patients with atopic eczema, which may be considered a general feature of atopic eczema skin.

Diagnostic Performance of Brain Natriuretic Peptide in Patients Suspected to Sepsis

Background: One of the main components involving in the pathogenesis and prognosis of sepsis and septic shock is natriuretic peptide. Hemodynamic changes in sepsis or septic shock might explain increased plasma levels of these peptides circulations. Objectives: The present study aimed to assess the value of brain natriuretic peptide (BNP) in prediction of sepsis state and its related morbidity. We also attempted to determine the best cutoff point of BNP for diagnosis of sepsis state in those with critical illnesses, admitted to the hospital. Patients and Methods: In a cross-sectional study on critically ill patients referred to infections unit of Hazrat Rasoul Akram Hospital, the enrolled patients were assigned to one of the sepsis (n = 30) and nonsepsis (n = 30) groups, based on their results of blood culture and clinical manifestations. Plasma level of BNP was measured by immunoassay. Results: In-hospital mortality was only observed in one patient suffering from sepsis. Hospital length of stay (LOS) was significantly longer in the sepsis group compared with the nonsepsis one (17.47 ± 10.10 days versus 7.93 ± 2.92 days). The plasma BNP level, as a marker, was significantly higher in the sepsis group than the nonsepsis one (786.87 ± 164.11 ng/mL versus 154.57 ± 44.67 ng/mL, P = 0.039). The BNP level was significantly correlated with some baseline variables including respiratory rate (beta = 0.295, P = 0.022) and ESR measurement (beta = 0.296, P = 0.022), but not with other characteristics. Through multivariable linear regression analysis, having other patients’ variables information including demographics and hemodynamic parameters, the BNP level was significantly higher in the sepsis group compared with the nonsepsis one (odds ratio = 1.008, P = 0.046). According to the receiver operating characteristic (ROC) curve analysis, BNP measurement had an acceptable value for discriminating sepsis and nonsepsis states (c = 0.734, 95% CI: 0.605-0.864, P = 0.002). The optimal cutoff point of BNP for discriminating sepsis and nonsepsis states was 170 ng/mL, yielding a sensitivity of 66.7% and a specificity of 60.0%. Conclusions: Elevated BNP level was associated with a significantly increased risk of sepsis state in critically ill patients.

Utility of N-Terminal Pro-B-Type Natriuretic Peptide in Patients Admitted to Intensive Care Unit

Utility of N-Terminal Pro-B-Type Natriuretic Peptide in Patients Admitted to Intensive Care Unit

Relationship between Coronary Collateral Circulation and Left Ventricular End Diastolic Pressure and Plasma Levels of N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Chronic Total Occlusion

PP-265 Numerous investigations have shown that well-developed coronary collaterals exert protective effect on left ventricular functions. But, relationship between collateral grade and left ventricular end diastolic pressure has not been studied in chronic total occlusion patients. Also, there are

Antibodies against cyclic citrullinated peptide in patients with nonrheumatoid arthritis disease

Antibodies against cyclic citrullinated peptide in patients with nonrheumatoid arthritis disease

Transdermal Application of Myelin Peptides in Multiple Sclerosis Treatment

Demonstration of efficacious antigen-specific therapy in multiple sclerosis. To assess the safety and efficacy of transdermally applied myelin peptides in patients with relapsing-remitting multiple sclerosis. One-year double-blind, placebo-controlled cohort study. Referral center. Thirty outpatients aged 18 to 55 years with relapsing-remitting multiple sclerosis. Skin patch with a mixture of 3 myelin peptides, MBP85-99, MOG35-55, and PLP139-155. MAIN OUTCOMES AND MEASURES Cumulative number of active gadolinium-enhanced (Gd+) lesions per patient per scan, mean volume of Gd+ lesions, cumulative number of new T2 lesions, and T2 lesion and T1 lesion volume change from baseline to the end of the study. Total number of relapses during the year of the study per patient (annual relapse rate), proportion of relapse-free patients, and proportion of patients with 3 months of confirmed disability worsening on the Expanded Disability Status Scale at month 12. All patients completed the study. Compared with placebo, treatment with a myelin peptide skin patch (1 mg) showed a 66.5% reduction in the cumulative number of Gd+ lesions (P = .02) during the 12 months of the study. The annual relapse rate in patients treated with a mixture of myelin peptides (1 mg) was significantly lower compared with the placebo group (0.43 vs 1.4; P = .007). Treatment with a myelin peptide skin patch was well tolerated and no serious adverse events were reported. In patients with relapsing-remitting multiple sclerosis, treatment with a myelin peptide skin patch significantly reduced both magnetic resonance imaging and clinically defined measures of disease activity and was safe and well tolerated.

Atrial Natriuretic Peptides in Patients with OME: Serous Otitis Media and Mucoid Otitis Media

Objectives: Atrial natriuretic peptides (ANPs) are located within extracardiac tissues known to play an important role in the maintenance of fluid/electrolyte homeostasis. It is not known whether ANPs are expressed in middle ear effusions (MEEs) and whether ANP is correlated in development of serous or mucoid effusion (OME). In order to determine whether secretion of ANP is affected in chronic disease condition, we compared the ANP concentration in the mucoid effusions with that in the serous effusions. Methods: MEE concentrations of ANP were measured in 21 patients (12 mucoid, 9 serous) with OME. The patients underwent myringotomy and/or insertion of a ventilation tube for treatment of OME and collected MEEs. The samples were divided into serous or mucoid types based on observation by the naked eye. ANP immunoreactive cells and ANP levels were measured in the tissues and effusions of the patients with OME, using IHC and radioimmunoassay. Results: In human MEE samples, ANP levels showed a significant increase with the mucoid effusions when compared with the serous effusions and control plasma. ANP concentration was increased in mucoid effusion but was decreased in patients with serous effusion and in control plasma. ANP-immunoreactive (ANP-IR) cells are showed in the tall columnar cells of the middle ear mucosa. Conclusions: Our results suggest that a high concentration of ANP in mucoid secretions promotes chronicity of mucoid otitis media and hypothesize that ANP may also play a role in the pathogenesis of OME through changes in the transport of water and ions across the middle ear epithelium.

Circulating chemokine (C-X-C Motif) receptor 5+CD4+ T cells benefit hepatitis B e antigen seroconversion through IL-21 in patients with chronic hepatitis B virus infection

Given the clinical significance of hepatitis B e antigen (HBeAg) seroconversion in chronic hepatitis B virus (HBV) infection, it is critical to elucidate the mechanisms regulating this process. In the present study, we found that the frequency of circulating chemokine (C-X-C motif) receptor 5 (CXCR5)(+) CD4(+) T cells was higher in patients who had achieved HBeAg seroconversion in both cross-sectional (P < 0.001) and longitudinal (P = 0.009) studies. These cells were able to produce a significantly higher level of intracellular interleukin 21 (IL-21) after stimulation with HBV peptides in patients with telbivudine-induced HBeAg seroconversion (P = 0.007). Furthermore, sorted CXCR5(+) CD4(+) T cells from HBeAg seroconverters boosted a higher frequency of antibody against hepatitis B e antigen (anti-HBe)-secreting B cells in coculture assay (P = 0.011). Of note, the increase in frequency of anti-HBe-secreting B cells was abrogated by soluble recombinant IL-21 receptor-Fc chimera (P = 0.027), whereas exogenous recombinant IL-21 enhanced this effect (P = 0.043). Additionally, circulating CXCR5(+) CD4(+) T cells shared similar phenotypic markers, and were positively correlated in frequency with, splenic follicular T helper cells. Circulating CXCR5(+) CD4(+) T cells, by producing IL-21, may have a significant role in facilitating HBeAg seroconversion in patients with chronic HBV infection.

Effect of hemodyalysis on precursor proBNP and glycosylated NT-proBNP in end-stage renal disease patients

Background: Brain natriuretic peptide (BNP) is established biomarker for cardiovascular diseases. Recent studies have shown that unprocessed precursor proBNP circulates in the healthy individuals, and its levels in plasma are increased in severe heart failure patients. However, since current BNP immunoassay crossreacts proBNP, it is important to consider the significance of proBNP on clinical situation of BNP elevation. In addition, recent study has shown that most proBNP is glycosylated, and that NT-proBNP is also glycosylated in human plasma, and current NT-proBNP assay underestimates the glycosylated NT-proBNP. Recent developed super-flux dialyzer can remove middle-sized molecular solutes such as β2-microgloburin. In this study, we investigated the effects of hemodialysis using super-flux dialyzer on the glycosylated proBNP, glycosylated NT-proBNP, and BNP-related other peptide in patients with end-stage renal disease (ESRD). Method: Thirty-six ESRD patients with hemodialysis were studied. We measured plasma BNP (which was defined as BNP messured with current BNP assay system), proBNP, and mature BNP (which was defined as total BNP- proBNP), by our newly developed immunoassay before and after hemodialysis. Plasma glycosylated NT-proBNP and nonglycosylated NT-proBNP was measured by Elecsys II after deglycosylating enzyme treatment such as neuramoinidase and O-glycosydase. We also measured plasma ANP and cGMP by radioimmunoassay. Results: After hemodialysis, BNP (-28%), proBNP (-20%), mature BNP (-47%), glycosylated NT-proBNP (-33%), nonglycosylated NT-proBNP (-45%), ANP (-52%), and cGMP (-63%) significantly decreased. The decreasing ratio did not correlated with any indices of reduction of plasma volume; however, these peptides decreased after hemodialysis in a molecular weight dependent manner. ProBNP/total BNP ratio and glycosylated NT-proBNP/nonglycosylated NT-proBNP ratio increased after hemodialysis. ProBNP/total BNP ratio positively correlated with hemodialysis vintage and negatively correlated with left atrial dimater and systolic blood pressure, whereas glycosylated NT-proBNP/nonglycosylated positively correlated with parathyroid hormone levels. Conclusion: These results suggest that hemodialysis modulates profile of BNP and its related peptide, and it may be important to consider the effect of this modulation on the pathological conditions in ESRD patients in super-flux dialyzer era.

The ANP Genetic Variant rs5068 Is Associated with Higher Circulating Concentrations of Natriuretic Peptides in Patients with Chronic Heart Failure

Atrial natriuretic peptide (ANP) possesses cardiorenal protective properties including natriuresis, aldosterone suppression and vasodilation. ANP also induces lipolysis in vitro and in vivo. Previous studies in general populations reported that the ANP genetic variant rs5068 is associated with increased plasma levels of ANP and B-type natriuretic peptide (BNP), lower blood pressure, and reduced risk of hypertension. We recently reported that in the general population from Olmsted County, MN the minor G allele of rs5068 is associated with increased levels of ANP, lower blood pressure and BMI, reduced prevalence of obesity and metabolic syndrome.

Interferon‐gamma ELISPOT detecting reactivity of T cells to TSH receptor peptides in Graves' disease

While thyrotrophin receptor (TSHR) is recognized as the main autoantigen in Graves' disease (GD), the actual antigen specificity of T cells that infiltrate the thyroid and the orbit is unknown. Identifying T cell responses to TSHR peptides has been difficult in the past due to the low frequency of autoreactive T cells and to the diversity of the putative epitopes identified by proliferation assays. We used the interferon-gamma ELISPOT assay to identify T cell reactivity to TSHR peptides in patients with GD. Peripheral blood T cells were exposed in vitro to four pools of 10 overlapping TSHR peptides. T cells from 11 of 31 (35%) patients with GD and 1 of 22 (4%) healthy controls reacted to at least one peptide pool (P = 0·009). Mean time since diagnosis was 3·2 years in responder patients and 5·6 years in nonresponders (P = 0·07). In two patients, T cell reactivity was observed shortly after radioiodine treatment and not thereafter. Our findings demonstrate that the ELISPOT assay is effective to test T cell reactivity in patients with GD and that patients with GD have significantly more interferon-gamma responses towards TSHR peptides than controls. The data suggest that screening for T cell responses in patients with GD might be more efficient in recent-onset disease or after radioiodine treatment.

Effect of different doses of spironolactone on cardiac function and plasma level of brain natriuretic peptide in patients with chronic heart failure and dilated cardiomyopathy

Objective To observe the effect of different doses of spironolactone on cardiac function and plasma level of brain natriuretic peptide (BNP) in patients with chronic heart failure (CHF) and dilated cardiomyopathy (DCM).Methods 110 cases of CHF and dilated cardiomyopathy (NYHA cardiac function class Ⅲ-Ⅳ) were randomly divided into large dose group (n=55) and small dose group (n=55),the two groups were treated with sprironolactone 20 mg/d and 60 mg/d respectively based on the routine anti-CHF therapy,the two group' s cardiac function and plasma level of BNP were evaluated 6 months after the treatment.Results The NYHA cardiac function of two groups were improved markedly before and after the treatment (P＜0.01); the small dose group' s LVEF was (31.23 ± 3.61)％ before the treatment and there was no statistical significant difference found compared with large dose group' s LVEF (30.33 ± 3.27)％,(P＞0.05) ; the small dose group' s LVEF was (39.37 ± 8.30)％ after the treatment and there was statistical significant difference compared with large dose group' s LVEF (45.17 ± 5.33)％,(P＜0.05) ;the small dose group' s plasma level of BNP was (973.25 ± 256.23) pg/ml before the treatment and there was no statistical significant difference compared with large dose group' s plasma level of BNP (991.07 ± 211.35) pg/ml,(P＞0.05);,the small dose group' s plasma level of BNP was (324.12 ± 122.43) pg/ml after the treatment and there was statistical significant difference compared with large dose group' s plasma level of BNP (200.58 ± 145.11) pg/ml (P＜0.05).But compared with the small dose group,there was significant decrease in the plasma level of BNP of the large dose group before and after the treatment (P＜0.05) ; the incidence of adverse reaction of small and large dose group were 11.1％ and 8.82％ respectively without any statistical significant difference between the two groups (P＞0.05).Conclusion Large dose of spironolactone on the basis of regular medicine treatment can lower BNP and improve the heart function of patients with CHF and DCM. Key words: Spironolactone; Dilated cardiomyopathy (DCM); Heat failure; Brain natriuretic peptide (BNP)

THU0497 Serum Antimicrobial Peptides in Patients with Familial Mediterranean Fever

BackgroundFamilial Mediterranean fever (FMF) is characterized by recurrent febrile inflammatory attacks of serosal and synovial membranes. Although genetic disorder leading to disease is almost the same, clinical phenotype is quite...