Levels Of 25(OH)D3 And Correlation Of Complication Of Chronic Heart Failure In Chronic Renal Failure Patients

1 Background & ObjectiveCurrently,there are about 120 per million population patients with chronic kidney disease?CKD?,The number of the patients who into end-stage renal failure?ESRD?need replacement therapy from 1.5-2.0 million in 2014-2016.Chronic renal failure?CRF?causes chronic glomerulonephritis by always gradually to the present diabetic nephropathy,in addition to hemodialysis?HD?,CRF complication of treatment has now begun a lot of conducting clinical research.Vitamin D is a steroid hormones also belong to the fat-soluble vitamins,is closely related to the human body is vitamin D2 and vitamin D₃.Vitamin D₃ in liver microsomal via single oxidase system function,generating 25-hydroxyl vitamin D₃?25?OH?₂ D₃?,25?OH?D₃ in the blood,the more stable and easy to measure,so the clinical commonly used 25?OH?D₃ evaluation of vitamin D.Vitamin D can promote calcium phosphorus absorption,balance the calcium phosphate levels,anti-inflammatory,antiproliferative,regulate cell apoptosis,various function mediated immune inflammation.Kidneys' 1 alpha hydroxylase,located in the renal tubular epithelial cells,the mitochondria is the main place to main producing active vitamin D.Therefore,CRF patients with adanced of calcium phosphate metabolic disorders,low activity of vitamin,resulting in parathyroid hormone?PTH?rise,PTH whole organs,produce toxic effect,increase the complications of CRF patients,so early detection of CRF patients,25?OH?D₃ occurrence,development and prognosis of CRF is of great significance.Based on the understanding of CRF 25?OH?D₃ is insufficient or a lack of,on the basis of further study on the relationship between 25?OH?D₃and cerebrovascular complications,discusses the importance of 25?OH?₂ D₃ in patients with CRF.2 Methods: Using contrastive study,the selection in October 2015 to March 2016 in yongchuan affiliated hospital of chongqing medical university renal medicine CRF patients in hospital,according to the patient every half a year is occurring dysfunction should be divided into control group and observation group.Control group 20 patients,15 cases of men,women in 5 cases,aged 37-82?54.75 + 13.3?,12 cases of chronic glomerular nephritis,diabetic nephropathy in 4 cases,3 cases of hypertensive renal impairment,other 1 case;Observation group 40 patients,26 cases of men,women,14 cases,aged 35 80?+ /-11.57 56.55?,25 cases of chronic glomerular nephritis,diabetic nephropathy 6 cases,4 cases of hypertensive renal impairment,polycystic kidney in 2 cases,other 3 cases.Inclusion criteria: 1)the CRF diagnostic reference according to the seventh edition \ "internal medicine\" the diagnosis of kidney [1],choose CKD stage 4-5 no blood dialysis patients;2)for nearly three months without serious infections,nearly a month without surgery history;3)during the experiment not complement calcium supplements,not taking hormone and cytotoxic drugs.Exclusion criteria:?1?for nearly three months serious infection and active disease,malignant tumor,liver disease;2)line has blood dialysis treatment,or jugular vein puncture for the treatment of catheter;3)acute heart failure is the healer.Cardiac function obstacle judgment using standard to guide the diagnosis and treatment of chronic heart failure,was diagnosed with chronic cardiac insufficiency at least one of the signs and symptoms of heart failure.Symptoms include shortness of breath at rest or with fatigue,orthopnea,nocturnal paroxysmal dyspnea,cough,cough up phlegm,or atypical symptoms of heart failure?fatigue,dizziness?;Signs include gallop,double lung field under wet rale,jugular vein filling,peripheral edema,weight gain,or rotating polygon.some basic evidence?pulmonary edema,enlarged heart,leaf water?.Cardiac function classification using the American New York heart association cardiac function classification standard.Class I: patients suffering from heart disease,but the daily activity is not restricted,general activity not cause excessive fatigue,palpitation,dyspnea,or angina.Class II: physical activity is limited by a mild heart attack patients,no self-conscious symptom when resting,but under the general physical activity can appear fatigue.Heart palpitations,difficulty breathing or angina.Level III: heart disease patients with limited physical activity significantly,less than the usual general activity is the cause of the symptoms.Level IV: heart disease patient cannot be engaged in any physical activity.Resting state under heart failure symptoms,physical activity after aggravating.Methods: Detection of serum25?OH?D₃: the enzyme-linked immunosorbent assay?ELISA?determination of two groups of 25?OH?D₃.Simultaneously measure the blood indexes,blood routine,biochemical detection,monitoring and hemoglobin?Hb?,albumin?propagated?,serum creatinine?Scr?,blood urea nitrogen?BUN?,total cholesterol?TC?,triglyceride?TG?concentration,brain natriuretic peptide?BNP?,hypersensitive c-reactive protein?CRP?.Carotid ultrasound examination: all the patients with carotid artery ultrasound doppler check,check the thickness of the bilateral common carotid artery,internal carotid artery,record the common carotid artery intima-middle thickness?IMT?,according to a 2014 large vascular lesions of non-invasive examination expert consensus [2] carotid atherosclerotic plaque formation standard: IMT was defined as intima-media thickness > 0.9 mm;IMT acuity 1.3 mm of carotid atherosclerotic plaque formation.Records in the two groups of IMT thickening and carotid atherosclerotic plaque formation in the number of patients.Auxiliary examination including echocardiographic left ventricular end-diastolic diameter,left ventricular ejection fraction.Statistical processing: using SPSS 17.0 statistical software processing data,measurement data to t test,counting data chi-square test or Fisher's exact probability method,with P < 0.05 for the difference was statistically significant.3 Results:3.1 between the two groups of serum 25?OH?D₃ and the comparison of blood test indexes: the control group of serum 25?OH?D₃ average concentration for?19.69 + 5.06?including g/L,?8.00-3.73?for observation group(including g/L,the differences between two groups was statistically significant?t = 10.134,P < 0.05?.Results show two groups of Hb and propagated concentration difference is no statistical significance?P > 0.05?.Observation group of Scr,BUN,TC,TG,BNP and CRP,left ventricular end-diastolic diameter level higher than the control group,ejection fraction is lower than the control group,the difference statistically significant?P < 0.05?.3.2 carotid ultrasound contrast between the two groups: observation group carotid ultrasound IMT values significantly higher than the control group,rate is significantly higher than the control group,carotid atherosclerosis and carotid IMT values between the two groups was statistically significant difference in rate of atherosclerosis?P < 0.05?.3.3 multivariate logistic regression analysis: the two groups of 60 patients as a whole,whether in cardiovascular events as the dependent variable,with gender,age,25?OH?D₃,Hb,propagated,Scr,BUN,TC,TG,BNP and CRP,left ventricular end-diastolic diameter and ejection fraction indicators as independent variables,multivariate logistic regression analysis,the results show that the low levels of 25?OH?D₃ is a risk factor for cardiovascular events.4 Conclusions:4.1 Serum 25?OH?₂ D₃ has certain correlation with cardioascular disease?CD?and death for patients with chronic kidney disease?CKD?.Higher serum 25?OH?D₃ every 10(including g/L,the patient's death risk decreases correspondingly by 14%.4.2 Low levels of 25?OH?₂ D₃ in patients with chronic kidney disease?CKD?the carotid IMT and carotid atherosclerotic disease,cardiovascular disease incidence were higher than normal 25?OH?D₃ group.The treatment and prevention of low 25?OH?D₃ disease may reduce atherosclerosis and cardiovascular disease have positive significance.