| Objective:Chronic heart failure(CHF) is the end-stage performance and main cause of death of cardiovascular disease.In recent years,the incidence of CHF increased year by year,it,s a serious threat for the life quality and healthy life of the patients.As soon as possible to give appropriate treatment may improve the prognosis.Patients with CHF may lead to secondary injury of kidney due to the hemodynamic disorder and the abnormal activation of neurohumoral.Deterioration of renal function which is an independent predictor of the mortality of CHF lead to further deterioration of cardiac function because of the sodium retention,electrolyte disturbances, acid-base imbalance and hematopoietic function decline.Renal function status of CHF is one of the important factors for evaluating the prognosis and making the treatment measures of CHF.Cys C is a sensitive indicator for reflecting the early injury of renal function. Compared with the serum creatinine,Cys C which is rarely affected by age,gender,muscle volume is produced Constantly.And it,s a better indicator for kidney function.Foreign studies indicate that Cys C can be used as a diagnostic marker of early renal damage in patients with CHF which is Closely related to the severity and prognosis of CHF.But this type of research is still few in our country.Detection and analysis of Cys C have been realized automaticly,but its clinical significance for CHF has not been widely recognized,So it is necessary to study the deeper relationship between Cys C and CHF.So the purpose of this study was to investigate the relationship between serum cystatin C level and chronic heart failure diagnosis,rencent prognosis.Metheds:Choose 138 patenits dignosed as chronic heart failure in the second hospital of Hebei Medical University from September 2013 to June 2014.The diagnosis of chronic heart failure reference Framingham diagnostic criteria,which will provide a comprehensive evaluation diagnosis combined with the clinical symp toms of patients(dyspnea,lower exercise tolerance),signs(pulmonaryrales,edema),change of electrocardiogram,chest X line(pulmonary congestion) and ultrasonic beckoning map change of cardiac structure and function.There were 47 patients with dilated cardiomyopathy,39 cases of ischemic cardiomyopathy,34 cases of rheumatic heart disease,14 cases with hypertension,and 4 cases of congenital heart disease.There were 50 cases of NYHA classification of cardiac function grade II,50 cases of NYHA grade Ⅲ,38 cases of NYHA grade IV.Exclusion criteria:acute myocardial infarction within 6 months,severe aortic stenosis,hypertrophic obstructive cardiomyopathy,malignant arrhythmia with hemodynamic disorders at the time of admission,primary glomerular disease,diabetes,malignant tumor,blood system diseases and autoimmune diseases and severe liver and kidney dysfunction,pregnancy.Choose 50 cases healthy people as control group at the same time,All enrolled objects were recorded the age,gender,height,weight, medical history.Abtained fasting blood samples before and after treatment which were used to evaluate the level of NT-pro BNP,Cys C,serum creatinine(SCr),blood urea nitrogen(UREA),blood uric acid(UA),and did ultrasonic beckoning diagram providing the value of LVEF.Heart failure group were given standard treatment during hospitalization according to 2013 China heart failure diagnosis and treatment guidelines.The heart failure group had been followed up for 6 months to record all-cause mortality,readmission due to heart failure,major cardiovascular events(heart failure,acute coronary syndrome,arrhythmia associated with hemodynamic disorder).Patients with CHF who were followed up for 6 months(except dead,HNYA IV and in hospital)did 6min walk test(6MWT)when they reviewed in hospital.The experimental data will be dealed with by using SPSS 13 software for statistical analysis.P<0.05 is considerred statistically significant.The results of measurement data were expressed as mean±standard.Comparison of the multiple samples that meet homogeneity of variance test will be analyzed by analysis of variance,if the difference was statistically significant the data will be analyzed by SNK-q test.Comparison of the multiple samples that can not meet homogeneity of variance test will be analyzed by Kruskal-wallis H test,if the difference was statistically significant the data will be analyzed by Nemenyi test.Linear correlation will be used for Correlation analysis.Multiple factors analysis will be analyzed by multiple stepwise regression analysis.Results:1 Comparison in general data,cardiac function and renal function between CHF group and control group:Proportion of two groups of patients age,sex,body mass index had no statistically significant difference(P>0.05).Comparison of the level of LVEF(38.95±9.76,65.09±4.33),NT-pro BNP(5000.76±3436.38,172.85±71.76),Cys C(1.57±0.80,0.85±0.22),SCr(95±42,70±20),UREA(8.0±3.4,6.0±3.4),UA(431.7±130.8,230.8±97.8)had statistically significant differences(P>0.05).There was no significant differences among heart function II, III, IV groups in drug application and composition of pathogeny.2 Comparison in the experimental indexes among NYHAⅡ,Ⅲ, groups Ⅳand control groupThe level of LVEF(47.39±6.21,34.84±7.21,31.70±7.91)of NYHA Ⅱ,Ⅲ,Ⅳgroups were significantly lower than that of the control group(61.09±4.33),there was statistically significant difference(P>0.05);and LVEF value was gradually reduced with the worsening of heart function,differences between the 3 groups are statistically significant(P>0.05).The level of NT-pro BNP(2109.98±1020.92,5402.39± 2050.06,8483.24±3650.33)of NYHA Ⅱ,Ⅲ, Ⅳgroups were significantly higher than that of the control group(172.85±71.76),there was statistically significant difference(P>0.05);and NT-pro BNP value was gradually increased with the worsening of heart function,differences between the 3 groups were statistically significant(P>0.05).The level of Cys C(1.20±0.35,1.50±0.43,1.75±0.63)of NYHAⅡ, Ⅲ,Ⅳgroups were significantly higher than that of the control group(0.85 ±0.22),there was statistically significant difference(P>0.05);and NT-pro BNP 8 value was gradually increased with the worsening of heart function, differences between the 3 groups were statistically significant(P<0.05). Comparison between NYHAⅡ group and control group in the level of SCr(70±20,75±30)had no statistically significant difference;Heart function III, IV group creatinine level(90+35,114+55) were significantly higher than that of the control group and NYHAⅡ group,in group IV creatinine levels was higher than that of cardiac function group III,the differences were statistically significant(P<0.05).3 Correlation analysis among NT-pro BNP,Cysc and LVEF before treatmentthe level of Cysc was negatively related to LVEF(r=-0.688, P<0.01);the level of NT-pro BNP was positively related to the level of Cysc(r= 0.624,P<0.01);the level of NT-pro BNP was negatively related to LVEF(r=-0.732,P<0.01).4 Comparison in NT-pro BNP and Cysc between before and after treatmentWith the improvement of the disease,the level of NT-pro BNP before treatment(5000.76±3436)was significantly higher than NT-pro BNP(2310.05±1335.60)after treatment,there was statistically significant difference(P<0.05).The level of Cysc before treatment(1.57±0.80)was significantly higher than Cysc(1.09±0.58)after treatment,there was statistically significant difference(P<0.05).5 Comparison in NT-pro BNP and Cysc between the event group and non groupNT-pro BNP in the event group(3858.56±2254.07)was higher than that of non group(1061.62±1054.03),there was statistically significant difference(P<0.05).Cysc in the event group(1.53±0.74)was higher than that of non group(0.86±0.34),there was statistically significant difference(P<0.05).6 Correlation analysis among NT-pro BNP,Cysc and 6min walk test6 minutes walk distance negatively related to NT-pro BNP(r=-0.653,P<0.01),6minutes walk test results negatively related to Cys C(r=-0.687,P< 0.01),6minutes walk test results negatively related to Cys C(r=-0.687,P<0.01).7 Logstic analysis of the independent risk factors for death in six monthes138 patients as a whole by multiple factors analysis.Having end events or not as the dependent variable. Age,gender,body mass index,cardiac Functional grading,LVEF,NT-pro BNP,Cys C,UREA,SCr,UA as the indepen-dent dent variables(use the midian of LVEF as limit for two classification variables,use the upper limit of the reference range of laboratory examination as limit for two classification variables or four classification variables for NT-pro BNP,Cys C,UREA,SCr,UA).The result of logstic analysis was that high levels of Cys C,and NT-pro BNP,low level of LVEF are independent risk factors for recent cardiovascular adverse events.Cys C in high level group the risk of recent cardiovascular adverse events was 4.5 times higher than that in low level group(OR=4.46 P:0.0443);NT-pro BNP in high level group the risk of recent cardiovascular adverse events was 2.5 times higher than that in low level group(OR=2.52, P:0.0525);LVEF in low level group the risk of recent cardiovascular adverse events was 7.01 times higher than that in high level group(OR=7.01, P:0.0215).Conclusions:1 CHF without primary renal diseases has early renal damage characterized by impaired glomerular filtration function;more severe heart failure and more obviously renal damage.2 The level of Cys C and NT-pro BNP are closely related to CHF,and they can reflect the Severity of cardiac function.3 The level of LVEF,Cys C and NT-pro BNP are closely related to the short-term prognosis of CHF,and Cys C is an one of the important predictors for the recent prognosis of CHF. |
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