| Objective:Chronic heart failure(CHF)is the end-stage manifestation of cardiovascular disease and the main cause of death.Its poor prognosis and high mortality are two major challenges in the cardiovascular field in the 21st century,which seriously threaten the quality of life and healthy life of patients.The prognosis of heart failure can be improved via early effective diagnosis and risk stratification and clinical intervention.The pathophysiological mechanism of heart failure is complex often with increased levels of parathyroid hormone(PTH),suggesting that PTH may be involved in its occurrence and development.This research aimed to discuss PTH's correlation with the severity and short-term prognosis of chronic heart failure and to guide early clinical intervention by detecting the level of parathyroid hormone in the blood of patients with chronic heart failure.Methods:84 patients with chronic heart failure who were hospitalized in three departments of cardiology,Second Hospital of Hebei Medical University from2017-01 to 2018-12 were selected as the heart failure group where there were54 males and 30 females classified by gender with an average level of64.40±11.58 years,where 23 cases of ischemic cardiomyopathy,16 cases of hypertensive heart disease,23 cases of dilated cardiomyopathy and 22 cases of valvular heart disease by pathogeny.The diagnosis of heart failure refers to201ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure.The control group was 21 cases without heart failure in the same period admitted in the third department of the second hospital of Hebei Medical University and within them there were 9males and 12 females with an average age of 65.71±11.71 years.1.Clinical data collection:(1)Basic information:such as age,gender,contact information and other basic information.(2)Personal medical history:current medical history,ast history,smoking history and drug use.(3)Laboratory testing:NT-proBNP was measured in venous blood within 2hours after admission,and serum creatinine(Scr),parathyroid hormone(PTH),serum calcium,total cholesterol and other biochemical index were detected in venous blood in the next morning.And ECCr of patients of heart failure was calculated.(4)Imaging data:Left ventricular ejection fraction(LVEF)was detected by simplified Simpson method in the supersonic ventricle of the Second Hospital of Hebei Medical University.2.Research Design:(1)Statistical analysis of PTH level and other clinical data was conducted between control group and heart failure group.(2)The heart failure group was divided into three groups:NYHA II,III and IV according to NYHA classification criteria where the PTH levels and other clinical datas among the three groups were analyzed statistically.(3)The correlation between PTH level in heart failure group and significantly different index among three groups was analyzed.(4)Patients were divided into endpoint event group and non-endpoint event group according to the condition that whether there was an endpoint event in follow-up result 1month later(including deterioration of cardiac function,re-hospitalization of heart failure and cardiogenic death)where the PTH level and other clinical data were analyzed statistically between the two groups.Statistically significant index were screened out to convert to grade based on mean,median or fixed grading for multivariate logistic analysis to evaluate the short-term prognostic value of PTH in patients with chronic heart failure.3.Statistical analysis:SPSS21.0 software was used to process experi-mental data in each group.All datas were tested for normality and homo-geneity of variance.Measurement data conforming to normal distribution were expressed by mean±standard deviation,while measurement data not conforming to normal distribution were expressed by median and quartile.Chi-square test was used to compare the rates among groups.Comparing the two independent samples,t-test was performed according to the normal distribution and homogeneity of variance,Wilcoxon rank sum test was used for inconsistency,single factor analysis of variance was used for comparison between multiple independent samples,Kruskal-Wallis rank sum test was used for inconsistency,LSD and SNK test was used for comparison between each two groups.Pearson correlation was used for the normal measurement data,and Spearman correlation was used for the non-normal or counting data.Independent risk factors were assessed by multivariate logistic regression.The difference was statistically significant with P<0.05.Results:1.General description(1)84 patients with chronic heart failure were taken as the heart failure group aged 42-96 years with an level of(64.40±11.58)years.(1)According to gender statistics:54 males(64.29%)and 30 females(35.71%);(2)According to pathogeny statistics:23 cases(27.38%)of ischemic cardiomyopathy,16 cases(19.05%)of hypertensive heart disease,23 cases(27.38%)of dilated cardiomyopathy and 22 cases(26.19%)of valvular heart disease;(3)According to NYHA classification statistics:20 cases(23.81%)of NYHA II,37 cases(44.05%)of NYHA III,27 cases(32.14%)of NYHA IV;(4)According to the statistics of endpoint events:there were 61 cases(72.62%)in the endpoint event group and 23 cases(27.38%)in the non-endpoint event group.(2)21 cases without heart failure in the same period admitted in the third department of Hebei Medical University aged 46-91 years were selected as the control group.And the mean±standard deviation was(65.71±11.71)years where there were9males(42.86%)and 12 females(57.14%).2.The comparison of clinical datas between heart failure group and control group(1)There was no significance on the comparison of gender,age,serum calcium,total cholesterol,low density lipoprotein,prevalence of diabetes,prevalence of hypertension and smoking rate(P>0.05).(2)PTH levels were77.90(47.65),27.10(16.40),NT-proBNP levels were 3626.47(2035.42),56.00(56.25)and Scr levels were 97.50(36.13),81.00(19.32)in CHF group and control group respectively.The levels of PTH,NT-proBNP and Scr in CHF group were significantly higher than those in control group(P<0.005).(3)The LVEF(%)of heart failure group and control group were 33.95(9.31)and 63.92(4.95)respectively.The LVEF(%)of heart failure group was significantly lower than that of control group(P<0.005).3.The comparison of clinical datas among NYHA grading groups(1)There were no significances in gender,age,serum calcium,total cholesterol,low density lipoprotein,causes of heart failure and smoking rate(P>0.05);(2)Serum creatinine levels were 85.50(40.73),96.00(33.55),110.00(51.00)in NYHA class II,III and IV groups,respectively.There was no significance in serum creatinine level between NYHA grade II and grade III,grade IV and grade III(P>0.05).Compared with NYHA grade II,serum creatinine level in NYHA grade IV increased significantly(P<0.005);(3)Comparison of endogenous creatinine clearance(ECCr):ECCr were 62.00(38.74),63.74(34.41),48.65(34.78)in NYHA grade II,III and IV groups respectively.There was no significant difference in ECCr between NYHA grade II and grade III,grade IV and grade III(P>0.05).Compared with NYHA grade II,the ECCr of NYHA grade IV decreased(P<0.05).(4)PTH levels in NYHA grade II,III and IV groups were 38.45(20.22),72.30(32.85),99.70(53.00),respectively.The PTH level of NYHA grade IV was significantly higher than that of grade III and grade III was significantly higher than that of grade II(P<0.005).(5)Comparison of NT-proBNP levels:NT-proBNP levels in NYHA class II,III and IV were 1485.86(1527.41),3692.47(741.86),9900.00(8730),respectively.The NT-proBNP level of NYHA grade IV was significantly higher than that of grade III,and that of grade III was significantly higher than that of grade II(P<0.005).(6)left ventricular ejection fraction LVEF(%)comparison:LVEF(%)of NYHA grade II,III and IV groups were 40.85±4.58,33.84±4.18,27.02±4.64,respectively.LVEF(%)of NYHA grade IV was significantly lower than that of grade III and grade III was significantly lower than that of grade II(P<0.005).4.Correlation analysis of PTH and NYHA grading index with statistical differences among groups in heart failure groupPTH was positively correlated with NT-proBNP(rs=0.744,P<0.005);positively correlated with NYHA classification(r_s=0.705,P<0.005);positively correlated with serum creatinine(r_s=0.365,P<0.005);negatively correlated with ejection fraction(EF%)(r_s=-0.684,P<0.005);negatively correlated with ECCr(r_s=-0.350,P<0.005).5.The comparison of clinical data between endpoint event group and non-endpoint event groupFor the factors that may affect the short-term prognosis of chronic heart failure,the comparison between the two groups found that:(1)there was no significance in gender,age and serum calcium(P>0.05);(2)PTH levels in the endpoint event group and the endpoint event group were 114.00(45.30),65.10(43.42);NT-proBNP levels were 11800.00(4569.10),3380.00(1710.93),respectively.The levels of PTH and NT-proBNP in the endpoint event group were significantly higher than those in the non-endpoint event group(P<0.005);(3)Serum creatinine levels in the endpoint event group and the non-endpoint event group were 108.00(34.00)and 89.70(36.30),respectively.The serum creatinine level in the endpoint event group was higher than that in the non-endpoint event group(P<0.05).(4)The ECCr levels of the endpoint event group and the non-endpoint event group were 46.84(34.91)and 63.34(33.3)respectively.The ECCr level in the endpoint event group was lower than that in the non-endpoint event group(P<0.05).(5)LVEF(%)was 25.37(5.33%)and 34.86(5.90%),and LVEF(%)of the endpoint event group was significantly lower than that of the non-endpoint event group(P<0.005).6.Logistic regression analysis of factors between endpoint event group and non-endpoint event groupTake it whether there is an endpoint event as dependent variable,and NT-proBNP(<450pg/mL=1,450?NT-proBNP<1700pg/mL=2,1700?NT-proBNP<4200pg/mL=3,?4200pg/mL=4),Scr(<97.5mmol/L=0,?97.5mmol/L=1),ECCr(<60.31mL/min*1.73m2=0,?60.31mL/min*1.73m2=1),LVEF(%)(<33.31%=0,?33.31%=1)and PTH(<77.90pmol/L=0,?77.90pmol/L=1),NYHA NYHA grading(?=1,?=2,?=3,?=4)as independent variable.It showed that PTH(P=0.032,OR=7.046)and NT-proBNP(P=0.022,OR=5.547)were risk factors for short-term prognosis of chronic heart failure,while LVEF(%)(P=0.018,OR=0.113)was protective factors for short-term prognosis of chronic heart failure.Conclusions:1.PTH significantly increases in patients of chronic heart failure,which increases with the increase of NT-proBNP level and NYHA grade,while with the decrease of LVEF(%),which could be used as an index to evaluate the severity of chronic heart failure.2.PTH,NT-proBNP and lower LVEF(%)were risk factors for short-term prognosis of chronic heart failure,and PTH could be one of independent risk factors for short-term prognosis of chronic heart failure. 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