| ObjectiveTo investigate the significance of microalbuminuria in the evaluation of the severity and prognosis prediction of the patients with chronic heart failure.MethodsSelected 162 cases of CHF patients, 97 cases of male, 65 cases of female, mean age (67.5±9.44) years. According to the American New York Heart Association (NYHA) cardiac function standards, they are devided into group NYHA gradeⅡ, group NYHA gradeⅢ, group NYHA gradeⅣ, number of patients in each group were 36 cases, 53 cases, 73 cases. All CHF patients were divided into three groups by urinary albumin / creatinine ratio : normal urinary group (45 cases), microalbuminuria group (77 cases), macroalbuminuria group (40 cases). Selected 83 cases in the normal people who received physical examination and patients with paroxysmal supraventricular tachycardia as the control group, mean age (62.7±10.40) years.All selected objects statistic their age, sex, smoking history and other information after admission. Measure blood pressure, heart rate, height, weight. Extract Fasting venous blood to measure serum creatinine (Cr), blood urea nitrogen (BUN), high sensitive C-reactive protein (HSCRP), brain natriuretic peptide (BNP), calculated glomerular filtration rate (eGFR)according to MDRD.Use echocardiography to measure left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD). Collect morning urine from overnight to measure urinary albumin / creatinine ratio (UACR). All CHF patients were followed up for 6 months, the method for the follow-up is outpatient clinic and telephone. The start time is the day that CHF patients was discharged after the treatment by our department, end point is the death due to cardiovascular disease or readmission because of aggravating heart failure.Results1.The UACR levels of normal control group, group NYHA gradeⅡ, group NYHA gradeⅢ, group NYHA gradeⅣwere 15.12±6.14,68.19±15.72,215.83±149.86,389.15±160.57, shows that as the grade of cardiac function was gradually increased, UACR levels increased too. Correlation analysis showed: UACR is positively correlated with BNP and cardiac function (r=0.799 P<0.05,r=0.908 P<0.05), negatively correlated with LVEF(r=-0.689 P<0.05), means that UACR levels can assess the severity of CHF.2. The proportion of patients who has a higher UACR in groups that defined as eGFR≥90,60≤eGFR<90,eGFR<60 were 40.00%,81.67% and 87.72%, the result shows the increase of UACR level is related with the decline of estimated glomerular filtration rate(P<0.001), lower eGFR accompany with worse renal function,higher level of UACR, the appearance of microalbuminuria would be increased.3. The etiology of chronic heart failure has no relation with the level of UACR(P>0.05), shows that microalbuminuria can used to assess chronic heart failure caused by any disease.4. The proportion of the appearance of end point in normal urinary group, microalbuminuria group, macroalbuminuria group were 17.78%, 32.47% and 42.50%, shows that if the level of UACR is higher, the death due to cardiovascular disease or readmission because of aggravating heart failure would be more common(P<0.05).Conclusions1. UACR levels increased as the cardiac function of heart failure patients was increased, UACR is positively correlated with BNP and cardiac function, shows a moderate negative correlation with LVEF. It has no relation with the cause of heart failure, prompt that UACR levels can used to assess the severity of CHF.2. The death due to cardiovascular disease or readmission because of aggravating heart failure would be more common if the level of UACR is higher, means that microalbuminuria defined by UACR levels has a certain value in judging the prognosis of patients with heart failure. |
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