| OBJECTIVE: To compare the changes of hs-cTnT, NT-proBNP and CK-MB levels in different CKD staging with non-dialysis patients, and to compare the accuracy of the ROC curve area in the diagnosis of cardiac structural function. To further predict the CKD non-dialysis patients with cardiac structure and function of the more accurate signs of myocardial injury to provide a clinical basis for the early detection of chronic kidney disease in patients with non-dialysis patients with cardiovascular disease to provide some value.METHODS: The inclusion criteria were the detectiondataofhs-cTnT,NT-proBNP and CK-MB, and the inclusion variables were included in the study of 137 cases of non-dialysis patients with chronic kidney disease in January 2015 -January 2017, Kunming Medical University, Including demographic and anthropometric data (gender, age, weight, blood pressure, etc.), primary renal disease,primary chronic glomerulonephritis, hypertensive renal impairment, lupus nephritis,obstructive nephropathy, ANCA-associated nephritis (Hs-cTnT), N-terminal B-type natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), total cholesterol (TC), total cholesterol (TC), total cholesterol (HDL), serum low density lipoprotein (LDL), hemoglobin (Hb), serum creatinine (Scr), urea nitrogen (BUN) and cardiac ultrasonography. The exclusion criteria were CKD5 Patients with diabetes mellitus were diagnosed and diagnosed with hypertrophic cardiomyopathy and had previous heart failure and acute coronary syndromes. In the first 3 months of enrollment, the patients were diagnosed with diabetes mellitus, Months have new infection infection Event of the patient. Active liver disease, malignant tumors, nearly 3 months of major trauma and surgical factors. 29 patients were selected as the control group in the second affiliated hospital of Kunming Medical University.Statistical methods: spss19.0 for data analysis, metrological data consistent with the normal distribution using the mean standard deviation of the difference between the two samples using t test, compared with three or more samples using single factor analysis of variance; count data The chi-square analysis was used to evaluate the diagnostic efficacy of the ROC curve. The diagnostic accuracy was evaluated by the area under the ROC curve, which was statistically significant with p <0.05.RESULTS:There were no significant differences in gender, BMI, TC, TG, HDL and LDL between the patients with different CKD groups (P> 0.05). At the SP, DP,BUN and SCr were higher than those in the control group (P <0.001). The difference of Hb and eGFR was statistically significant (p <0.001). CKD5 group and CKD3-4 group were lower than CKD 1-2 group, the difference was statistically significant (p<0.001), SP, DP, BUN, SCr index than CKD 1-2 group 1 High, the difference was statistically significant (p <0.001). The levels of plasma hs-cTnT, NT-proBNP and CK-MB in CKD1-2 group were not significantly different from those in control group.The levels of plasma hs-cTnT, NT-proBNP and CK-MB in CKD3-4 and CKD5 (P<0.001). Compared with CKD group, the difference of hs-cTnT between CKD3-4 group and CKD1-2 group was statistically significant (p <0.001), and there was significant difference between the two groups ), Hs-cTnT in CKD5 group (0.2308 ±0.1329) was significantly higher than CKD1-2 group (0.0071 ± 0.00641),CKD3-4 group (0.0324 ± 0.02664),the difference was statistically significant (p<0.001).There was no significant difference in CK-MB between CKD3-4 group and CKD 1-2 group, CKD5 group (4.31 ± 2.461) was significantly higher than CKD 1-2 group (1.66± 1.475),CKD3-4 group (2.31 ± 1.554) The difference was statistically significant (p<0.001). The same NT-proBNP in CKD3-4 group and CKD 1-2 between the no significant difference in CKD5 group (1054.21 ± 241.70) was significantly higher than CKD1-2 group (84.25 ±37.728),CKD3-4 group (475.08 ± 388.761),the difference was statistically significant (p <0.001). The positive rate of blood hs-cTnT in CKD3-4 group was higher than CKD1-2 group (P <0.001), and the positive rate of CKD5 group was 56.7% higher than CKD1-2 Group (2.8%), CKD3-4 group (28.6%),the difference was statistically significant (p <0.001). The positive rate of NT-ProBNP in CKD3-4 group and CKD1-2 group was statistically significant (p <0.001),the positive rate of CKD5 group was 53.3.% higher than CKD1-2 group (0%), CKD3- 4 groups (11.9%), the difference was statistically significant (p <0.001). The positive rate of serum CK-MB in CKD3-4 group and CKD1-2 group was no significant difference, CKD5 group positive rate (30%) was significantly higher than CKD1-2 group (2.8%), CKD3-4 group (4.7%), the difference was statistically significant (p<0.001). (P <0.05). There was no significant difference in CKD group (P <0.05).There was no significant difference between CKD group and CKD group (P <0.05).There was no significant difference between CKD group and CKD group (P <0.05)LVMI, E / A <1, LVH were higher than CKD 1-2, the difference was statistically significant (P <0.001), LVEF decreased, the difference was statistically significant (p<0.001), CKD5 group LvDd, (P<0.001). The LVEF index was lower than that of CKD3-4 group (p<0.001). The expression of LvDd, IVST and LVPWT in CKD5 group were significantly higher than those in CKD3-4 group (P<0.001), and the difference was statistically significant LVMI, E / A <1, LVH were higher than CKD 1-2 group, the difference was statistically significant (P <0.001), LVEF index decreased, the difference was statistically significant (p<0.001) .According to statistical analysis The levels of hs-cTnT, NT-proBNP and CK-MB in patients with left ventricular hypertrophy were significantly higher than those without left ventricular hypertrophy (P<0.001),left ventricular hypertrophy group hs-cTnT,NT-proBNP, CK-MB level was higher than that in normal control group (p <0.001),CKD with left ventricular diastolic dysfunction (P <0.001). The levels of hs-cTnT,NT-proBNP and CK-MB in the left ventricular diastolic dysfunction group were significantly higher than those in the left ventricular diastolic dysfunction (P <0.001).The levels of plasma hs-cTnT, NT-proBNP and CK-MB in the patients with CKD were measured and the left ventricular hypertrophy was evaluated by the curve of the working curve of the subjects.Through the ROC curve, the CK- (P <0.001). CK-MB had the highest accuracy of left ventricular hypertrophy, followed by NT-proBNP and hs-cTnT. According to CKH patients with plasma hs (AUC = (0.774 ± 0.048) (95%CI: 0.679), and the left ventricular diastolic function was evaluated by using the curve of activity of the subjects. -0.868, p <0.001), the highest accuracy is CK-MB,followed by NT-proBNP, hs-cTnT.CONCLUSION: 1.CKD non-dialysis patients in the prevalence of heart structure and function changes and early have emerged.The levels of plasma hs-cTnT,NT-proBNP and CK-MB in patients with CKD were significantly higher than those in patients with non-dialysis. The levels of plasma hs-cTnT NT-proBNP and CK-MB The expression of hs-cTnT, NT-proBNP and CK-MB in patients with left ventricular hypertrophy and left ventricular diastolic dysfunction were significantly higher than those in patients with cardiac hypertrophy and centrifugal hypertrophy. hs-cTnT,NT-proBNP, CK-MB increased. The ROC curve area of plasma hs-cTnT,NT-pro-BNP and CK-MB in left ventricular hypertrophy and left ventricular diastolic dysfunction were the highest in CKD non-dialysis patients. Detection of CK-MB can be used as one of the reliable indicators of CKD early cardiovascular disease. |
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