The Pathogenesis And Clinical Studies Of Chronic Heart Failure During Hospitalization In Patients With Worsening Renal Function

Objective:To study the change of decline in renal function during hospitalization RAAS hormones, inflammatory mediators and NT-ProBNP changes in patients with chronic heart failure; to explore the mechanism of RAAS activation and inflammatory mediators; NT-ProBNP and sodium retention state; small volume hypertonic saline the solution treatment of chronic heart failure patients on renal function.Methods:This study was selected to meet the standard chronic heart failure patients66cases,36cases of male and female30cases. Divided into normal renal function decline in renal function group, HSS treatment group.①cross-sectional study-comparison of renal function and renin-angiotensin-aldosterone system (RAAS) components and inflammatory mediators (tumor necrosis factor-a and interleukin-6) the value of the relationship between②control:the establishment of matched control subjects by age group, gender, and duration of the decline in renal function.③intervention study:the decline in renal function in patients with hypertonic saline treatment group, with and without treatment with hypertonic saline group.Results:①In addition to the duration of the first25%of creatinine group and25%creatinine group differences, there are significant differences (P <0.05), general characteristics in patients with chronic heart failure on admission in the other groups P>0.05.②chronic heart failure during hospitalization in patients with normal renal function, a decrease of the group and between the HSS group of the general characteristics by statistical tests between the three groups no significant differences in age, sex ratio, and the cause of the composition and heart function.③In addition to serum creatinine with normal renal function and decreased group, the difference between the descent group and the HSS group there were significant sex outside was no significant difference between other renal function indicators (P>0.05).④In addition to the urine volume and sodium retention remain integral in the normal renal function and fall between the two groups, urine output decline in renal function between the group and HSS groups have significant difference (P <0.01), the average systolic blood pressure, mean diastolic blood pressure of hospital and NT-ProBNP There was no significant difference among the three groups (P>0.05). NT-proBNP and sodium retention points was positively correlated (P<0.01).⑤of RAAS components and inflammatory mediators in chronic heart failure patients with normal renal function and fall between groups, between the drop group and HSS group significant difference (P<0.05), renal function between the normal group and HSS group. difference. Which ALD group difference was significant (P<0.01), the ALD renal function decline group than the normal group significantly increased.⑥twice hospitalized during the commonly used anti-heart failure drugs in addition to diuretic dose significantly different (P<0.01), the dose of other drugs without significant difference (P>0.05).Conclusion:①The study, hematologic indicators more repeated in different time periods, the absolute increase or the percentage increased to the sCr baseline date (sCr rise≥26.5μmol/L (0.3mg/dl) or the sCr rising≥50%), acute renal decline criteria could have been more rapid, the severity of the economy, more accurate and feasible assessment of renal function decline. For acute decompensation of chronic heart failure patients condition changes, the detection of simple basic indicators for evaluation of renal function decline.②The study found that chronic heart failure patients admitted to hospital a significant positive correlation between the sodium and water retention points and serum creatinine. Heart failure in patients with sodium retention, elevated central venous pressure, which spread to the renal vein and kidneys, causing renal dysfunction may be one of the pathogenesis of chronic heart failure patients with reduced renal function.③the present study,66patients most of the long-term use of ACEI and/or ARB, observed during hospitalization RAAS each component, regardless of whether renal function decline, and its level increased in varying degrees, but the decline in renal function group1obvious, statistically significant compared with normal renal function group. The decline in renal function group actively a large number of diuretic may further activation of the RAAS reason. RAAS activation play a positive role to compensatory cardiac function in heart failure early, but persistent activation lead to heart, worsening of renal function.④chronic heart failure patients during hospitalization with or without the decline in renal function, the circulation of inflammatory cytokines (TNF-a,IL-6) were higher, there are significant differences among the three groups, indicating that the decline in renal function to stimulate a large number of inflammatory factors produced increased heart and kidney damage. Decline after intervention by the HSS, the circulation of inflammatory cytokines.⑤small volume hypertonic saline solution to fully inhibit the decline in renal function in patients with chronic heart failure, RAAS, aldosterone inhibition. In addition, due to the improvement of renal function, inflammatory mediators also will be significantly decreased.