| Objectives:Investigating the changes of blood B-type natriuretic peptide(BNP), homocysteine(HCY), high sensitive C-reactive protein(hs-CRP), D-dimer(D-D) of patients with chronic heart failure, analysising correlation between BNP and HCY, hs-CRP, D-D, to evaluate the diagnostic value of the receiver operating characteristic curve(ROC) for each indicators in chronic heart failure.Methods:Selecting 123 patients of hospitalization with chronic heart failure in the Second Hospital of Shanxi Medical University from October 2010 to March 2015 as the observation group, 74 cases were male, 49 cases were female, mean age is 63.43 ± 12.19 years. The patients will be divided into grade Ⅱ ~ Ⅳ by New York Heart Association(NYHA) diagnostic criteria. Chronic heart failure causes include Coronary atherosclerotic heart disease, hypertensive heart disease, rheumatic heart disease, hypertrophic cardiomyopathy, dilated cardiomyopathy, etc. Completing routine examination at the time of admission, electrocardiogram, chest anteroposterior radiography and other tests, The next day fasting test items including routine blood analysis, urinalysis and sediment microscopy, the conventional and occult blood test, liver and kidney function, electrolyte,plasma lipids, blood glucose, coagulation test, serum free triiodothyronine(FT3), serum free thyroxine(FT4), thyroid stimulating hormone(TSH), patients fasting venous blood collection, laboratory high sensitive C-reactive protein(hs-CRP), homocysteine(HCY), B-type natriuretic peptide(BNP). In addition to select the same period of 46 patients with risk factors but no symptoms of chronic heart failure as the control, including 26 males, 20 females, mean age is 61.43 ± 11.55 years,completing the same physical examinations,carrying out the same physical objects of imaging and laboratory the same with the research group. Except for serious liver and kidney diseases, congenital heart disease, acute and chronic infections, autoimmune diseases, thyroid disorders, pulmonary embolism,other arterial and venous thrombosis diseases, cancer and so on of the above two groups of patients.Results:(1)Blood level of BNP, HCY,hs-CRP, and D-D with CHF patients was higher than that of control group(p < 0.05), and NYHA classification increased, the higher the indicators level.(2)BNP was positively correlated with HCY, hs-CRP, DD with CHF patients respectively(r = 0.288,0.449,0.757, P <0.05).(3)ROC curve showed: area under the curve(AUC) of BNP is 0.984, an area of the standard error is 0.007, the diagnosis of chronic heart failure was significant(p <0.05). According to this ROC curve, determining the optimal cut point of BNP is 138pg/ml, the sensitivity is 95.1%, specificity is 91.3%.(4)ROC curves evaluates the sensitivity and specificity of BNP tested individually is 88.2% and 77.8%. Four indicators joint detection, diagnostic sensitivity and specificity were 88.2% and 94.4%, specificity of combined detection is higher than BNP single detection.Conclusions:1.Serum BNP, HCY, hs-CRP, D-D levels are higher in CHF, and increased with NYHA functional class, the indicators increased gradually.2. BNP was positively correlated with serum HCY, hs-CRP, D-D respectively in CHF.3. Application of ROC curve in the evaluation of the four indicators in the specificity of the diagnosis of CHF is higher than BNP individual test. |
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