NT-probnpevaluates The Effect Of Hemodialysis On Cardiac Function In Renal Failure Patients Combined With Different Heart Function

Objective:The main purpose of the study is to assess the impact of hemodialysis on cardiac function of patients with chronic congestive heart failure(CHF) by detecting the N terminal B brain natriuretic peptide(NT-pro BNP) and left ventricular end-diastolic diameter(LVDd) of the renal failure patients combined with different heart function failure that has to accept hemodialysis.; To analyze the degree of improvement of cardiac function, before and after the first hemodialysis, on patients with different LVDd, to provide a basis for renal failure patients combined with heart failure acceptance of the degree of benefit and prognosis of hemodialysis, and to develop appropriate treatment programs.Methods:Eighty-one male patients with renal failure(CR) in need of hemodialysis diagnosed at Ping Xiang people's hospital from June 2012 to January 2014, of which58 cases of patients combine with varying degrees heart failure, and the age span was50-70 years. The experimental research content and consent were informed from all patients in advance, the condition of all patients enrolled were relatively stable,Cardiac function was graded on II-III by NYHA level, neither acute cardiovascular disease, acute pulmonary embolism and pericarditis nor other diseases occurred within three months; A total of 25 healthy volunteers were enrolled as normal control.All patients in the first week hemodialysis did not appear in deterioration of cardiac function, hypertension crisis as severe coagulation disorders and other complications.All patients were divided into three groups according to the echocardiography left ventricular end-diastolic diameter(LVDd): group A: 50 mm <LVDd ?55mm, 20 cases,group B: 55 mm <LVDd ?60mm 20 cases, group C: 60 mm <LVDd ?70mm, 18 cases.Germany Fresenius 4008 S dialysis machine and blood filtration device Fresenius polysulfone membrane dialyzer were used in this research, the treatment of all patients during routine use of erythropoietin, antihypertensive drugs, active vitamin D, phosphorus binding agent, the first day of dialysis solution for 2 hours, 2 days 3hours dialysis, dialysis four hours on day 3, day 5 of dialysis 4 hours, the first 7 days of dialysis 4 hours press dialysis regimen 1 week after the review patient cardiac ultrasound measurements LVDd. All patients who get dialysis should sit quietly for30 minutes, the blood sample was collected to detect the chemical index, and the bio Merieux analyzer MINI-IDAS was used to detect the NT-pro BNP.The US GEvivid-7 ultrasound diagnostic apparatus was used to do Echocardiography, and the apical four-chamber view was used to exclude the impact of breathing, the image acquisition before the patient is asked at the end of exhalation and temporarily hold patients' breath. Probe is placed on the left ventricular apex anatomy, probe shows marked point to 3 o'clock, the scanning direction to right scapula, scanning plane cross the midline through the heart structure, access to the apical four-chamber view, echocardiography by experienced doctors to operate with the same indicators measured twice and averaged as the experimental research data.After one week hemodialysis, the above detection was done again, and data were recorded.Results:(1) NT-pro BNP levels and LVDd in chronic renal failure patients were generally higher than in the control group, and the combined heart failure group was also higher than unconsolidated heart failure group(P <0.01). The sensitivity and specificity of NT-pro BNP detected in MHD patients with heart failure were 86.2% and 72%respectively, The sensitivity and specificity of applications echocardiography were65.5% and 78% respectively, once combined they were 90% and60% respectively.(2)NT-pro BNP decreased significantly in each group than before dialysis(P<0.05), in particular, group C decreased obviously(P <0.01), NT-pro BNP in group B was lower than group A(P <0.05).After hemodialysis, the LVDd in group C was lower than before(P <0.05), but there were no statistical difference between group A and group B. After dialysis patients' creatinine decreased significantly(P <0.01), but among groups creatinine decrease was no significant difference(P> 0.05).CONCLUSION:The plasma NT-pro BNP levels have a high diagnostic value for cardiac function in renal failure patients, and the sensitivity was better than LVDd. Hemodialysis can improve chronic heart failure, NT-pro BNP level was positive correlated with LVDd value before dialysis, and the sensitivity of NT-pro BNP was better than LVDd, LVDd value was greater, the greater benefit were got from dialysis.