| BackgroudChronic kidney disease (CKD) is a rising incidence of clinical syndrome. And bloodvolume unbalance, cardiovascular disease (CVD) is a majorcomplication and the most common cause of death in patients with end-stage kidneydisease. It is often needed that frequent blood test in order to closely monitor the heartfunction and blood volume change in patient, and even to have invasive examination notonce such as central venous indwelling catheter, in the result,patients’ physical pain andeconomic pressure, also the clinical doctor’s work burden is coming. Therefore, to createan accurate, convenient and noninvasive blood volume measurement and heart functionevaluation method is particularly important.Nowadays,the heart function evaluation in clinical is rely on symptoms, signs, someserological indexs, and some single ultrasonic indicators, but the quantitative relationshipbetween these indexes is undefined, what’s more, the subjective composition and otherinfluencing factors is too much, hence, clinical cardiac function evaluation is not standard extremely. While blood volume determination method is numerous, the commonly usedblood volume measuring methods include radioactive isotope labeled blood products(RBC) for red cell blood volume, albumin or use dye (Evans blue or indole cyanidegreen)for plasma blood volume, and recent research of acute hemodilution,（hydroxyethyl）,on-line blood volume determination,bioelectric impedance analysis,the density of pulsedye spectrophotometry, formula estimating and so on. With chromium isotope labeling ofred blood cells (51cr red blood cells) way to measure red blood cells, is regarded as the"gold standard" of blood volume measurement, but the operation iscomplicated,time-consuming,expensive process, radioactive,professional needed, theseshortcomings make its clinical application limited to some extent,so just currently used inscientific research. Clinical use of the assessment of blood volume state is central venouspressure (CVP),its operation is simple, but still need invasive operation to line centervenipuncture, and relationship between the CVP and blood volume is limited toqualitative research at present, it cannot yet calculate the concrete numerical of bloodvolume, and that, the impact factors of CVP is various, so the accuracy of the bloodvolume measurement with single index has been questioned by more and more.This study creat a computer module that can aaccurate, convenient, less injury to evaluateblood volume and cardiac function,through consults a large number of literature at homeand abroad, summarizes all kinds of accurate approachs of blood volume assessment andcardiac function evalution, and through collect a large number of cases, correlation,regression analysis and comparison research, correcting some influencing factors. formany of CKD patients who needs to monitor changes in blood volume and evaluatecardiac function bring convenience, reduce their physical pain, improve the diagnosticaccuracy, and save huge economic expenses.ObjectiveSynthesize evaluation of blood volume and cardiac function methods, correctionimpactfactors; creative a computer module for the cardiac function evaluation and blood volume measurement in CKD patients;conduct the clinical comparison research of the computermodule created above.Methods1. Consulted a large number of domestic and foreign literature and throughcomprehensive analysis, to select ideal and can digitize method of the blood volumemeasuremet and cardiac function evalution, integrated various methods for advantage,and corrected impact factors.2. Create computer module: use9million pixel digital camera to shoot the landscape andmedicine images, processed and sorted by photoshop software. Computer module ofblood volume measurement and cardiac function evalution in CKD patients wereestablished. After debugging qualified and encryption package, installed on a dedicatedcomputer.3. The comparative study on the cardiac function assessment: randomly selected agroup of suspected merge heart failure patients with CKD, the new module was used toassess cardiac function（Heart failure digital diagnosis，HF-DigD）, at the same time,recorded the NT–BNP diagnose, LVEF diagnose, and assessed cardiac function by twoclinical experienced doctors，income data for chi-square test evaluation of diagnostic testand ROC Analysis.4. Comparative study on the blood volume assessment: a group of CKD patients werechoosed at a random,with new module respectively calculate blood volume between anytwo time points (BVd), at the same time,to test tube central venous pressure (CVP) inthis two time points, record the percentage change record of BVdand CVP between thistwo time points, income data for chi-square test, correlation and regression analysis. Results1. The computer module for the cardiac function evaluation and blood volume assessmentin chronic kidney diseases patients has the following features:(1) The module used in evaluating cardiac function is the heart function evaluation system(HFEJS), the latter is through summarizing the current cardiac function evaluationmethod, comprehensive analysis of each method, the advantages and disadvantagesbetween the heart function is selected the optimal evaluation method, and the calibrationand debugging qualified rear, then put into clinical use. And the blood volumedetermination is by nearly a calculation formula of the intelligent computer.(2) In strict accordance with the system operation instructions, instant pop-upman-machine dialogue window, make operationer convenient use; Automatic errorcorrection function, thinking mistakes are avoided; Part of the data manual input isforbidden, prevent the occurrence of human error.(3) The ratio of renal function indexes (Scr, ScysC), and b-type brain natriuretic peptide(BNP, Nt-proBNP, pro-BNP) is calculated, eliminates the GFR decline for detectingb-type brain natriuretic peptide concentration; And blood volume evaluation module, thesoftware is eliminated the renal anemia in hemoglobin (HGB) decline in influence on redblood cells deposited (Hct), makes use of red blood cells deposited determination of bloodvolume results more accurate.(4) According to operating procedures can obtain single heart function and blood volumeof test result, accurate, intuitive, convenient, and the results can be saved automatically, atany time to view and print. And the results list below with the test result analysis of theclinical significance for clinical reference, easy to understand.2. On the basis of clinical actual diagnosis. This study by chi-square test, HF-DigD, Nt-proBNP diagnostic, LVEF, P value is1,0,0, respectively HF-DigD and no statisticaldifference between clinical diagnosis results, Nt-proBNP diagnostic, LVEF between no clinical diagnosis results were statistically significant differences.3. In this paper, a clinical diagnosis of actual standard for HF-DigD, Nt-proBNPdiagnostic, LVEF evaluate diagnostic test:93.22%HF-DigD sensitivity was93.22%,especially, about an index was0.81; Nt-proBNP diagnostic sensitivity was100%,especially, about an index of0.5151.22%; LVEF diagnostic sensitivity of33.90%,specially degrees, and an index of0.3197.56%. Comprehensive analysis of HF-DigDdiagnostic performance is the best.4. On the basis of clinical practical diagnosis, ROC curve was studied for the HF-DigDscores,0.976, the area under the ROC curve area of standard error is0.012, that use HF-DigD clear heart failure diagnosis has a significant score, area of95%confidence interal(0.953,1), not including0.5, the same conclusion, namely the HF-DigD score, thegreater the bigger heart failure probability. The best point for heart failure diagnosis: HF-DigD score is3.955%, the sensitivity of0.983,0.707specific degrees.5. At each time point in the clinical actual measured between the central venous pressuregradient (Δ CVP) as the standard, test the module between two time points to calculatethe blood volume change rate (Δ BVd) and Δ CVP difference, through the chi-square test,P=0, can think of two kinds of blood volume assessment no difference statistically.6. Through correlation analysis, Δ CVP and Δ BVd positively correlated between%,correlation coefficient r=0.858, P value is0; By the regression analysis to get theregression equation between them: Δ CVP=0.012+0.246×Δ BVd, the regressionequation P=0.Conclusion1. Our heart function module of the plait of the HF-DigD chi-square test and clinicaldiagnosis of actual do no difference (P=1), and the Nt-proBNP diagnostic and LVEFwere difference (P=0), show that the new plait heart function module can accurately assess cardiac function and heart failure diagnosis.2. The same after a diagnostic test evaluation, heart function module of the plait of thediagnostic performance of HF-DigD also is the best, sensitivity93.22%,93.22%, and anindex of0.81).3. HF-DigD and clinical practical diagnosis of ROC curve study also showed that HF-DigD diagnostic performance is good, can accurately evaluate cardiac function (area underthe ROC curve0.976, the area of standard error is0.012,95%confidence interal,0.953-1),and3.955for HF-DigD for best heart failure diagnosis node (0.983sensitivity and0.983).4. Δ BVd%and Δ CVP%chi-square difference, suggests new plait blood volumeassessment module by determination of blood volume also can correctly reflect the bodycapacity load case, and positively correlated between (correlation coefficient r=0.858, P=0), the regression equation obtained has statistical significance (P=0).5. New plait of cardiac function in patients with chronic kidney disease and the evaluationof the blood volume of the digital module is a variety of evaluation methods, index, theresult of the formula, and eliminate the influence factors of calibration, evaluation resultsare accurate, the evaluation process is convenient, smart, cheap, intuitive, noninvasive,with strong clinical practical value. |
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