| Objective Chronic heart failure and renal failure often coexist and influence each other.cardiorenal syndrome means the two diseases coexist. This study was performed to detect serum in patients with chronic heart failure and urinary neutrophil gelatinase associated lipocalin (NGAL), serum cystatin-C (cystatin C), urine protein (mALB) level and cardiac function, renal function, to explore the predictors of its effects on chronic cardiac insufficiency occurred in patients with renal failure.Methods In120cases of patients with chronic cardiac insufficiency, cardiac function classification in New York Heart Association classification standard,40cases of healthy persons as control group. Enrolled patients were excluded from diabetes, primary kidney disease, cerebrovascular disease, malignant tumor, blood diseases, autoimmune disease and various infections, selected the top1weeks without taking the renal toxicity of drugs. According to the patients with renal function, divided into CRS group and non CRS group. All patients with cardiac ultrasound in detecting left ventricular ejection fraction (LVEF) and left ventricular diastolic diameter (LVIDd), biochemistry and blood routine, blood, urine NGAL, Cystatin-C (Cys-C), N-N-terminal brain natriuretic peptide (NT-proBNP), urinary albumin index. Using the MDRD formula calculation of glomerular filtration rate (GFR), creatinine clearance rate was calculated by Cockcroft-Gault formula (Ccr). Statistical analysis using SPSS13.0statistical software, measurement data were expressed as X±s, two sample t test was used to compare the different, compared with single factor analysis of variance, the Pearson product difference or Spearman rank correlation analysis and evaluation of the NGAL and other variables.P<0.05said the difference was statistically significant.Results The CRS age group was significantly higher than that in non CRS group. A larger proportion in coronary heart disease, hypertension in the basis of chronic heart failure etiology, and these two kinds of disease in CRS group was significantly higher than that in non CRS group. The CRS group compared with the non CRS group, red blood cell count, hemoglobin, serum creatinine, urea nitrogen, NT-proBNP and cystatin C (Cys-C) level were significantly different. The cardiac ultrasound detection index, left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVDs), left ventricular end diastolic diameter (LVDd), interventricular septal thickness (IVSd) has a significant difference in CRS group and non CRS group. There was significant difference between the NYHA classification of cardiac function in CRS group and non CRS group. The variety of urine trace protein levels along with elevated heart function classification, its concentration gradually increased; glomerular protein (mALB, IgG) and renal tubular protein (β2-MG, a1-MG) has a linear relationship; the positive rate of combined detection of urine protein increased compared with the single. The eGFR is used to evaluate the prognosis of CRS group and non CRS group of two groups, when eGFR<60, the mortality rate increased significantly, especially when eGFR<30, significantly increased mortality. NYHA cardiac function grade IV in group LVEF, hemoglobin, hematocrit, serum albumin and the Ccr value is NY-HA cardiac function grade II group decreased significantly, the difference was statistically significant (P<0.05), and left ventricular end diastolic diameter, blood creatinine, blood NGAL and cystatin C value is NYHA cardiac function grade II grade group increased significantly, the difference was statistically significant (P<0.05). NYHA cardiac function grade IV group and NYHA cardiac function grade Ⅲ group determination of urinary NGAL value is NYHA functional class II group were increased significantly, the difference was statistically significant (P<0.01). Correlation analysis of NGAL and other indexes showed that, serum NGAL and serum creatinine (r=0.22, P<0.05), urinary NGAL (r=0.29, P<0.05) positive correlation, and NYHA classification (r=0.24, P<0.05), systolic blood pressure (r=0.28, P<0.01), diastolic blood pressure (r=0.37, P<0.001), serum cystatin C levels (r=0.20, P<0.05) positive correlation, plasma NGAL and serum albumin (r=-0.23, P<0.05), GFR (r=-0.38, P<0.001) were negatively correlated, but had no significant difference with other indicators (P>0.05). Urinary NGAL and serum creatinine (r=0.21, P<0.05) are related, and creatinine clearance rate (r=-0.22, P<0.05) negative correlation,.Conclusions Elderly patients with chronic heart failure can be found in early renal damage can not be found by normal renal function test, and with the increase of heart function classification, concentration of urine trace protein all increased significantly, suggesting that microalbuminuria determination can help to discover early renal damage. The results of this study also shows that, for kidney damage in patients with chronic heart failure patients, serum and urine levels of NGAL, blood NT-proBNP and cystatin C is an early biomarker has high sensitive and predictive value. Is the important risk factors of prognosis in patients with heart failure. |
PDF Full Text Request