Relationship Between Uric Acid Level And Clinical Prognosis In Patients With Chronic Heart Failure

Heart failure(HF)is a complex syndromea including a series of clinical symptoms of the retention of body fluid and limited activity endurance due to impaired ventricular filling and/or pumping blood pressure caused by various cardiac structural abnormalities and/or dysfunctions.It is the end-stage manifestation of cardiovascular diseases and many other diseases,posing a serious threat to people’s physical and mental health.Accompanied by accelerated social development,changes in people’s lifestyles and population aging,the incidence and prevalence of heart failure are continuously increasing,which is also a major cause of global mortality.At present,the incidence of heart failure in the world is about 1.3%-5.6% and the prevalence is about 1%-2%.The total number of heart failure patients is about 26 million.Our country’s blood disease report also points out about 4.5 million people with heart failure in our country.With the continuous improvement of the medical environment and the continuous improvement of medical technology,the survival rate of patients with heart failure is better than before,but the mortality rate is still high.The 5-year survival rate of patients with clinical symptoms of heart failure is only 35%.The 1-year mortality rate of severe heart failure patients is up to 50%.Therefore,early identification of patients with heart failure,individualized treatment and long-term reasonable intervention of risk factors of heart failure is needed to reduce hospitalization and mortality.In recent years,many studies have shown that serum uric acid is a metabolic product of oxidative stress.Serum uric acid levels are involved in the development of heart failure,and are also closely related to the severity and prognosis(including death)of patients with heart failure.Therefore,the predictive reduction of serum uric acid levels can delay the deterioration of heart failure patients and improve cardiac function.However,there is still controversy over whether the reduction of serum uric acid level itself has a positive effect on the improvement of cardiac function and the clinical prognosis of heart failure.ObjectiveThe aim of the study is by observing the concentration of serum uric acid(SUA)in chronic heart failure(CHF)patients with hyperuricemia(HUA)to observe the correlation between level of SUA and heart failure.Meanwhile the objective is to investigate the changes of SUA before and after treatment and the effect of SUA itself on the cardiac function and the clinical prognosis in heart failure patients with HUA by oral sodium bicarbonate tablets.Methods:1 The study subjects:A total of 168 patients with chronic heart failure(CHF),NYHA functional class Ⅱ~ and with hyperuricemia were selected Ⅱfrom June 2016 to May 2017 in the NO.1 central hospital of Baoding.The patients were enrolled between the ages of 18 and 90 years.96(57.1%)were male and 72(42.9%)were female.CHF diagnosis according to Framingham diagnostic criteria,combined with the patient’s symptoms,signs,echocardiography,chest X-ray,ECG and related medical history.Grading method of cardiac function in patients with heart failure accords to the New York Heart Association(NYHA)classification of heart failure.2 The group of subject and treatment plan: The 168 patients of chronic heart failure according to the principle of randomization were randomly divided into two groups: the control group and the test group.The control group(n=84)received the treatment of primary disease and the basic drug treatment of CHF,such as diuretics,beta blockers,digoxin and other cardiac drugs,vasodilators,ACEI(antagonizing angiotensin converting enzyme Agent)or the ARB(angiotensinⅡreceptor antagonist)and so on.The test group(n = 84)was given sodium bicarbonate 0.5g three times daily on the basis of the control group.All patients were followed up for 6 months.3 Observation index: Recording the general information of the selected patients,including gender,age,smoking,drinking,classification of cardiac function,complications and drug applications.Fasting elbow venous blood was collected before treatment and 6 months after treatment to detect SUA concentration and B-type natriuretic peptide concentration.LVEF and LVEDD were measured by echocardiography.The blood pressure level,serum sodium concentration,presence or absence of gastrointestinal reactions,and cardiovascular end-point events(including heart failure hospitalization and heart failure death)were recorded before and after treatment.4 Statistical analysis: All statistical analysis was performed by spss 19.0 software.The measurement data in the study was described as mean ± standard deviation if they belong to the normal distribution.The comparison among groups was analyzed by the independent sample t-test.The same variable before and after treatment was compared with the matched sample ttest.One-way ANOVA was used to compare multiple sample means,and the correlation between the two variables was analyzed using Pearson correlation analysis.Counts in this study were calculated using the compositional ratio or rate(%),and Fisher’s exact test or chi-square test was used to analyze the differences between the groups.Analysis of P<0.05 for the difference was statistically significant.Results:1 There was no significant difference in the general information(sex,age,comorbidities,drug application,etc.)between the test group and the control group(P> 0.05).2 There were no significant differences in the levels of SUA,BNP,LVEF,LVEDD,systolic blood pressure,diastolic blood pressure and serum sodium concentration between the control group and the test group before treatment(P> 0.05).3 With the increase of cardiac function based on NYHA classification,the LVEF levels gradually decreased,while the levels of SUA,BNP,LVEDD gradually increased(all P<0.05).4 There was a linear positive correlation between SUA level and plasma BNP level(r= 0.797,P <0.001)and LVEDD(r = 0.597,P <0.001),while a linear negative correlation between SUA level and LVEF(r =-0.659,P <0.001).5 Compared with those before treatment,the levels of LVEF,SUA,BNP and the level of LVEDD in test group and control group were significantly increased at 6 months after treatment,with statistical significance(P <0.05).After 6 months of treatment,LVEF in test group was significantly higher than that in control group,while SUA,plasma BNP and LVEDD levels were significantly lower than those in control group(all P <0.05).6 Compared with before treatment,systolic blood pressure and diastolic blood pressure were significantly lower in the test group and control group at 6 months after treatment(P<0.05),and serum sodium levels were not significantly different(P>0.05).After 6 months of treatment,there was no significant difference in systolic blood pressure,diastolic blood pressure,and serum sodium level between the test group and the control group(all P > 0.05).After 6 months of treatment,there was no significant difference in the incidence of gastrointestinal adverse reactions between the two groups(P> 0.05).The incidence of cardiovascular events in the test group was significantly lower than that in the control group(P < 0.05).Conclusion:1 SUA elevation is a risk factor for heart failure.SUA increased with the increase of cardiac function grade.SUA level can reflect the severity of patients with heart failure.2 Reducing SUA levels can improve the cardiac function in patients with chronic heart failure.3 Reducing SUA levels can reduce the incidence of rehospitalization rate in patients with chronic heart failure.4 Sodium bicarbonate tablets can reduce SUA levels and are clinically safe and reliable.