| Objective:To study in hemodialysis patients with plasma NT-proBNP level changes, and combined with ultrasound examination in patients with ventricular cardiac structure, hemodynamic and functional changes in order for the early diagnosis of hemodialysis patients with the diagnosis of heart failure provide a reference.Methods:All diagnostic and inspection operations are the subject of obtaining informed consent, strict inclusion criteria and exclusion criteria. The subjects were patients from September2012to October2013in Zaozhuang City Hospital during hemodialysis and with complete data, a total of110cases. All patients on dialysis2-3times a week, each dialysis time was4h, each hemodialysis for more than four months.110patients underwent routine blood tests related indicators, simultaneously NT-proBNP, echocardiography examination.Hematology detection:NT-ProBNP, urea nitrogen, creatinine, calcium, hemoglobin, hematocrit and so on. Hemodialysis before specimen collection:Before the start of hemodialysis are not yet connected to extracorporeal device, not yet applied heparin, extracted from the patient’s upper forearm vein. Blood samples were collected at the end of dialysis:hemodialysis both ends, before the return of blood from the venous dialyzer collection. All blood samples blood immediately after submission, the application of automated analyzers for testing. Predialysis hematology results of this study as observed indicators calculated Kt/V according to dialysis after blood biochemistry.MHD patients sit-10min, before hemodialysis extracted peripheral blood2ml, was taken after2000r/min plasma, serum NT-proBNP levels in patients using electrochemiluminescence immunofluorescence.All patients were treated with the American GE formula V70Chi-dimensional echocardiography detects heart star, whose probe frequency of2.0to4.3Hz. Conventional ultrasound section under LAD, LVEDd, LVESD, IVST, LVPWT, LVEP. LVMI calculated according to Devereux and Reichek formula.Results:1, the three groups were pairwise MHD patients in age, sex, weight, body mass index, duration of dialysis, systolic blood pressure, diastolic blood pressure, serum creatinine, blood urea nitrogen, hemoglobin, serum albumin and Kt/V and other relevant physical and chemical data the comparison, P values>0.05, the difference was not statistically significant.2, MHD patients with heart failure and NT-proBNP, LVEF, LVEDd, weight increased between dialysis has a positive correlation, in which NT-proBNP correlation coefficient0.571, P value of0.008, LVEF correlation coefficient of0.472, P value0.005, indicating that NT-proBNP and LVEF was significantly correlated with both. MHD patients with heart failure and LVESD, LEMI, Kt/V was negatively correlated. With clinical symptoms of heart failure and age, blood pressure, HGB, duration of dialysis, blood urea nitrogen, serum creatinine, serum albumin no correlation, the correlation data is not statistically relevant.3, MHD cardiac function D grade and C grade, C grade and B grade, B grade and A grade in NT-proBNP levels compared to the P-value<0.05, the difference was statistically significant. And in hemodialysis patients with heart failure severity NT-ProBNP levels were significantly higher trend.4, NT-proBNP levels and LVEDd, LVMI, SBP was positively correlated with hemoglobin, hematocrit, LVEF was negatively correlated with the duration of dialysis and LVPWT no correlation (P>0.05).5, LVEF, LVEDd’s statistic heart function D grade and C grade, C grade and B grade, B grade, compared with the A-level P-value<0.05, the difference was statistically significant; Table6. Aggravation of heart failure, LVEF decreased gradually, LVEDd gradually increased.6, MHD HF application NT-proBNP had a sensitivity of84.6%and a specificity of57.2%; application echocardiography were67.4%,68.9%; combined diagnosis were92.3%,73.3%.Conclusion:1, MHD patients with heart failure and NT-proBNP significantly correlated, NT-proBNP and LVEF was significantly correlated with the number. HF can cause reduction of LVEF, and the higher the degree of exhaustion, LVEF lower, NT-proBNP increases more as a significant, LVEF decreased, while LVEDd increased gradually.2, NT-proBNP levels and left ventricular diastolic dysfunction, ventricular remodeling and hypertension, and has nothing to do with the age of dialysis patients, patients with HF can effectively prompted MDH lesions and exhaustion.3, NT-proBNP combined echocardiography indicators, such as LVEDd, LVMI, SBP, can significantly improve the MHD patients with heart failure diagnostic sensitivity and specificity for the diagnosis of HF patients MDH significance. |
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