| Heart failure is a group of clinical syndromes that results from heart structure or dysfunction that leads to ventricular filling and/or damage to the blood,it is the final stage of various heart diseases.In recent years,with the aging of population,the incidence of heart failure,readmission rate and mortality rate have been increasing year by year,which seriously endangers the health of human life and the quality of life.Accurate diagnosis of heart failure is crucial to saving lives,guiding treatment and improving the prognosis of patients.Now some indicators are recognized as indexes to the diagnosis and prognosis of heart failure,including clinical manifestations,B-type natriuretic peptide(BNP)and N-terminal pro-B-type natriuretic peptide(NT-proBNP),Left ventricular ejection fraction(LVEF),etc.Cardiac Troponin I(cTnI)as a marker of myocardial injury,can be able to reflect the higher sensitivity,high specificity of myocardial damage,and is of important value in disease prognosis assessment.Objective:The purpose of this thesis is to evaluate the clinical value of short-term prognosis of patients with chronic heart failure based on a combination of cardiac troponin I(cTnI)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)tests in patients with heart failure.Methods:Based on the diagnostic criteria in the “Guide to the Diagnosis and Treatment of Heart Failure in China”,437 heart failure patients who were admitted to the Second Hospital of Jilin University from March 2016 to October 2017 were selected for a group study:1.Patients with heart failure were divided into two groups based on the median NT-proBNP of 4110.0 ng/L: NT-proBNP ? 4110.0 ng/L was the low NT-proBNP group,219 patients,158 males and 61 females,the age range was(64.26±8.95)years;NT-ProBNP>4110.0 ng/L was the high NT-proBNP group.Therewere 218 patients,145 males and 73 females,with an average age of(63.96±10.33)years.2.According to the cTnI level,437 patients with heart failure were divided into the cTnI elevated group(cTnI>0.023 ng/mL),a total of 117 cases,the average cTnI value was(0.0394±0.0177)ng/mL;the cTnI normal group(0.01 ng /mL?cTnI?0.023ng/mL),320 cases,the average cTnI value was(0.0143±0.0036)ng/mL.Clinical data such as sex,age,and body mass index were collected and electrocardiogram was performed in the patients.LVEF levels were measured by echocardiography within 24 hours.At the same time,routine blood tests were performed;serum cTnI and NT-proBNP levels were detected at the time of admission.The number of rehospitalization cases and cardiac deaths were recorded within 6 months after discharge from patients with heart failure.The patients were excluded with the following diseases:acute coronary syndrome within 30 days before hospitalization;cardiac surgery was performed within 3 months prior to hospitalization;patients undergoing cardiopulmonary resuscitation before hospitalization;patients with heart failure with severe liver and renal failure;patients with benign/malignant tumors and hematologic disease patients with heart failure;patients with heart failure with hypoxic conditions such as respiratory failure;patients with stroke,subarachnoid hemorrhage.SPSS22.0 statistical software was used to process the data.Measured data were expressed as mean±standard deviation(`x±s);single-factor t-test was used for comparison between groups,and one-way analysis of variance was used for intragroup comparison.Spearman rank correlation analysis was used to analyze the correlation between the two quantitative variables.The comparison of count data and rate was performed by c2-test;COX proportional hazards regression model was used to compare the risk ratio of occurrence of end events between multiple groups;P<0.05 was considered statistically significant.Result:1.Comparison of cTnI and LVEF values of different NT-proBNP levels: Troponin expression was higher in the high NT-proBNP group than the low NT-proBNP group(P<0.05).The left ventricular ejection fraction in the high NT-proBNP group was significantly lower than that in the low NT-proBNP group(P<0.01).2.The relationship between the short-term prognosis and the end-point event of different levels of NT-proBNP: Compared with the low NT-proBNP group,the rate of readmission and cardiac death increased in the high NT-proBNP group,and there was a statistically significant difference between the two groups(P<0.01).3.Comparative analysis of NT-proBNP and LVEF values of different cTnI levels:NT-proBNP levels in patients with elevated cTnI were significantly higher than those in normal cTnI groups((49)<0.01);differences in LVEF levels between the two groups were not statistically significant((49)>0.05).4.The relationship between short-term prognosis and end point events of different cTnI levels: The rate of readmission and cardiogenic mortality was higher in the cTnI-elevated group than in the normal group.There was a statistically significant difference between the two groups((49)<0.05).5.The correlation of cTnI,NT-proBNP and LVEF levels: There was a positive correlation between cTnI and NT-proBNP levels,and the correlation coefficient was r=0.416,(49)<0.01.The LVEF value was negatively correlated with NT-proBNP level.The correlation coefficient was r=0.321,(49)<0.01;The correlation coefficient between cTnI level and LVEF value was 0.163,=0.125,and the difference was not statistically significant.6.The risk ratio of NT-proBNP combined with cTnI in predicting the end event risk: COX proportional hazards model analysis found that NT-ProBNP ? 4110.0 ng/L and cTnI> 0.023 ng/m L group had the highest risk ratio of death,heart failure and hospital admission time(HR14.029,CI 2.66-73.99,P<0.01).Conclusion:1.The levels of cTnI and NT-proBNP are related to the short-term prognosis of chronic heart failure.The higher the levels of cTnI and NT-proBNP,the worse the short-term prognosis of patients with heart failure is.2.Serum cTnI and NT-proBNP levels are positively correlated.Combined detection of cTnI and NT-proBNP has important value in predicting the short-term prognosis of heart failure. |
PDF Full Text Request