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رسالة ماجستير / علي عبد الحسن



Background: Heart failure (HF) is a condition in which the heart can no longer pump blood as efficiently as it used to. This is lead to a complex of clinical symptoms like (dyspnea, orthopnea, lower limb swelling). BNP is a neurohormone released from myocardium and increased when failure of heart is occure and used for diagnosing heart failure. TNFα, IL-6, and IL-18 is inflammatory cytokines, its concentration increasing in patients with heart failure, this caused by inflammation which is present in heart with failure.

Objectives: This study was designed for examining serum concentrations of TNFα, IL-6, and IL-18 in patients with HF, examining whether this cytokines was involved in the pathophysiology of the HF syndrome, and investigating the effectiveness of using BNP concentration as an indicator for heart failure.

Subjects and methods: The current study is a cross sectional study that was carried out in the center of Diyala province, Baquba Teaching Hospital, to determine the serum concentration of BNP, TNF-α, IL-6, and IL-18 in patients with heart failure. The samples were collected in 2 and a half months, from January the 15th to April the 1st 2019.

A total of 150 serum samples were collected . 100 patients with diagnosed heart failure, and the rest apparently healthy. The age range was 30-89 years, 50 of them were males, and 50 were females. BNP, TNFα, IL-6, and IL-18 concentrations were tested in the serum samples using the BNP, TNFα, IL-6, and IL-18 ELISA kit (from SunRed company – China).  Human privacy was respected by taking the parents’ verbal consent. Statistical analysis of data was carried out using the Statistical Packages for Social Sciences (SPSS), Version 25. Statistical significance was considered whenever the P value was equal to or less than 0.05.

Results: The results showed that the BNP concentration range in HF group patients (50-1600) was wider than that in healthy control group (5-160) with a statistically significant difference between HF group and healthy control group (P = 0.0001). A statistically significant association was found between IL-6 concentration and heart failure ( P = 0.0001 ), IL-18 concentration and heart failure ( P = 0.0001 ), and TNFα and heart failure ( P = 0.005 ). Also there is statistically association between grade of heart failure with BNP, TNFα, IL-6, and IL-18 with P value of 0.0001, 0.0001, 0.016, and 0.0001 respectively.

There are several factors and conditions that affect the concentration of these cytokines such as medication and clinical cardiac problems.

Conclusion: The concentrations of TNFα, IL-6, and IL-18 is elevated with increasing the severity of heart failure accompanied by BNP concentration elevation, where the increase the HF grade, the elevation the concentration of these cutokines.

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