| Objective:The purpose of this study was to test B-type natriuretic peptide(BNP) and N-terminal pro-B-type natriuretic peptide(NT-pro BNP) levels in serum and to discuss the effect of the evaluation of cardiac function in clinical work.Methods: The CKD patients, admitted in the Nephrology Department of the Second Affiliated Hospital of Dalian Medical University from 2014 August to 2014 December were enrolled,all patients were in line with K/DOQI diagnostic criteria for chronic kidney disease. The patients having the following conditions were excluded from the study: malignancies, serious endocrine diseases, autoimmune diseases, severe ventricular arrhythmias,acute cerebrovascular disease, severe liver dysfunction, trauma, cardiac tamponade, acute coronary syndrome, congenital heart disease and other diseases;patients treated with corticosteroids, sex hormones, thyroxine, adrenergic antagonist analogues or drugs. The MDRD formula was used to calculate the glomerular filtration rate of the patients. According to the K/DOQI guidelines of the diagnosis and staging of chronic kidney disease,the patients were divided into CKD1-2 group, CKD3 group and CKD4-5 group. According to the New York Heart Association,these patients were further divided into four groups- NYHA I group,NYHA II group, NYHA III group and NYHA IV group. Basic clinical information of all the research patients was collected, including gender, age and so on. The serum creatinine was assessed by autobiochemistry machine. Enzyme linked immuno sorbent assay(ELISA) was used to detect the serum levels of BNP and NT-pro BNP. Color doppler ultrasound was used for cardiac examination,inspect the ejection fraction,interventricular septalthickness,left atrium diameter,main pulmonary artery,ascending aorta diameter,left ventricular end-diastolic dimension,right ventricular diameter.All statistical analyses were performed using SPSS 19.0, p values<0.05 were considered as statistically significant.Results: 75 CKD patients were enrolled in the study-CKD1-2 group, CKD3 group and CKD4-5 group, each containing 25 cases. According to NYHA functional class, there was 23 cases in NYHA I group, 20 cases in NYHA II group, 14 cases in NYHA III group and 18 cases in NYHA IV group.1.Age, gender and BMI have no significant difference between the group of CKD1-2,CKD3 and CKD4-5(P>0.05),it is comparable. Age, gender and BMI have no significant difference between the group of NYHA I,NYHA II,NYHA III and NYHA IV(P>0.05),it is comparable.2. There was no significant difference of BNP,EF,LA,LVEDD,IVS,RV,AAO and MPA between different patients of CKD group(P>0.05). However NT-pro BNP levels of patients with CKD stages 4-5 were higher than that of CKD stages1-2 and 3 group(p<0.01). With the deterioration of renal function, blood concentrations of NT-pro BNP increased significantly.3.Deterioration of cardiac function lead to higher blood concentrations of NT-pro BNP and BNP(P<0.01), higher value of LA, LVEDD, IVS(P<0.05), lower value of EF(P<0.01),and there was no significant change in RV,AAO,MPA(P>0.05).4.In chronic kidney disease patients with heart failure, NT-pro BNP concentrations increased with renal dysfunction(P <0.05), renal function has little impact on BNP concentrations(P>0.05).5. The level of BNP was negatively correlated with EF(r=-0.571,p=0),positively related with LA(r=0.325,p=0.002),LVEDD(r=0.290,p=0.006),IVS(r=-0.234,p=0.022.However there was no correlation between BNP with RV( r=0.030,p=0.400,AAO(r=0.137,p=0.146),MPA(r=0.124,p=0.144).6. The level of NT-pro BNP was negatively correlated with EF(r=-0.377,p=0),positively related with LA(r=0.315,p=0.003),LVEDD(r=0.241,p=0.016),IVS(r=0.231,p=0.023. However there were no correlation between BNP with RV(r=-0.030,p=0.400),AAO(r=0.136,p=0.263),MPA(r=0.49,p=0.338).Conclusions:Both of NT-pro BNP and BNP can be used as indicators of the evaluation of cardiac function. In the evaluation of cardiac function in chronic kidney disease status, BNP levels was more objective compared with NT-pro BNP levels. |
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