The Early Prediction Value Of NGAL Combined With A Variety Of Urinary Microproteins In Patients With Hospitalized Heart Failure Complicated With CRS

Objective:Cardiorenal syndrome?CRS?can be divided into 5 types clinically.This paper mainly studied?-CRS.The purpose of this study was to analyze the changes of NGAL and urinary microproteins in hospitalized patients with heart failure and their effects on cardiac and renal function,so as to explore the predictive value of NGAL and many kinds of urinary microproteins in early renal function injury in heart failure patients.Methods:A total of 109 patients with heart failure were collected from the four cardiovascular wards of Hebei people's Hospital from June 2018 to December 2019.Patients with primary nephropathy,acute coronary syndrome,pulmonary embolism,end-stage renal disease,autoimmune disease,severe infection and malignant tumor were excluded.According to whether the glomerular filtration rate?GFR?was greater than 60ml/?min·1.73m²?,the patients were divided into non-CRS group?n=73?and CRS group?n=36?.Sixteen patients without cardiac and renal insufficiency who were hospitalized at the same time were selected as the control group in this study.The medical history and physical examination of all selected patients were recorded in detail.The laboratory indexes of the patients were recorded,including blood routine,biochemical items,serum and urine NGAL,microproteins?Um Al B,urinary?₁-MG,urinary?₂-MG,urinary TRF,urinary NAG and urinary RBP?,and related indexes of echocardiography.SPSS 21.0 statistical software was used to process and analyze the above data,and the difference of P<0.05 was considered statistically significant.Results:1. The average age of non-CRS group was 67.56±14.21 years,and that of CRS group was 72.94±13.04.There was significant difference between the two groups?P<0.05?.The constituent ratios of hypertension,coronary heart disease and diabetes in the CRS group were 83.3%,66.7%and 52.8%respectively,which were significantly higher than those in the non-CRS group?P<0.05?.There was significant difference in NYHA cardiac function grade between the both groups?P<0.05?.The median NYHA grade??grade?in CRS group was significantly higher than that in non-CRS group??grade?.2. Compared with non-CRS group,HBG and HCT in CRS group decreased significantly?P<0.05?,UA,K,TC,LDL-C and CRP increased significantly?P<0.05?.Compared with non-CRS group,BNP,LAD,LVESD and LVEDD in CRS group increased significantly,LVEF in CRS group decreased significantly?P<0.05?.3. There was significant difference in the levels of SCr and BUN between CRS group and non-CRS group?P<0.05?,but there was no significant difference between non-CRS group and control group.There were significant differences in serum NGAL,urine NGAL,urine TRF,urine RBP,urine?₁-MG,urine?₂-MG,urine NAG and Um Al B among control group,non-CRS group and CRS group?P<0.05?.In the non-CRS group,the levels of SCr,BUN,blood NGAL,urine NGAL,urine TRF,urine RBP,urine?₁-MG,urine?₂-MG,urine NAG and Um Al B in the NYHA?group were higher than those in the control group?P<0.05?,and the levels of blood and urine NGAL,urine TRF,urine RBP,urine?₁-MG,urine?₂-MG,urine NAG and Um Al B in the NYHA?group were higher than those in the control group?P<0.05?,and the levels of Um Al B,urine TRF,urine?₁-MG and urine NAG in the NYHA?group were higher than those in the control group?P<0.05?.4. The level of serum NGAL was positively correlated with NYHA grade?r=0.62,P<0.001?,BNP?r=0.35,P<0.001?,CRP?r=0.30,P<0.01?,SCr?r=0.65,P<0.001?,BUN?r=0.51,P<0.001?,urinary NGAL?r=0.62,P<0.001?,urinary TRF?r=0.46,P<0.001?,urinary RBP?r=0.43,P<0.001?,urinary?₁-MG?r=0.49,P<0.001?,urinary?₂-MG?r=0.52,P<0.001?,urinary NAG?r=0.35,P<0.001?and Um Al B?r=0.27,P<0.05?.It was negatively correlated with LVEF?r=-0.22,P<0.05?and GFR?r=-0.63,P<0.001?.The level of urinary NGAL was positively correlated with NYHA grade?r=0.41,P<0.001?and BNP?r=0.43,P<0.001?,SCr?r=0.39,P<0.001?,BUN?r=0.51,P<0.001?,serum NGAL?r=0.62,P<0.001?,urinary TRF?r=0.46,P<0.001?,urinary RBP?r=0.39,P<0.001?,urinary?₁-MG?r=0.50,P<0.001?,urinary?₂-MG?r=0.39,P<0.001?,urinary NAG?r=0.33,P<0.001?and Um Al B?r=0.41,P<0.001?.It was negatively correlated with GFR?r=-0.43,P<0.001?.5. The area under the ROC curve was used to assess the ability of serum and urinary NGAL to predict renal dysfunction in heart failure patients.The results showed that the area under the curve of serum and urinary NGAL was0.894 and 0.733?P<0.01?,respectively.The best critical values for predicting the deterioration of renal function were 161.45ng/ml and22.65ng/ml,respectively,with a sensitivity of 94.4%and 52.8%,and a specificity of 69.9%and 84.9%,respectively.6. Age,NYHA?,coronary heart disease,hypertension,diabetes,BUN,BNP,CRP,UA,K,HBG,LVEF,serum NGAL,urine NGAL,multiple urinary microproteins were taken as independent variables,and renal function was insufficiency as dependent variables for multivariate logistic analysis.It showed that age and high levels of serum NGAL,CRP,UA and BNP were risk factors for CRS in patients with heart failure?P<0.05?.Conclusions:1.In hospitalized patients with heart failure,the glomerular and tubular function were impaired to varying degrees,and the elevation of serum,urinary NGAL and various urinary trace proteins was earlier than the traditional markers of renal function.Therefore,the combined detection of the above indicators could identify such early renal injury,and the more severe the degree of heart failure,the more obvious the renal injury.2.Serum NGAL and urinary NGAL levels in patients with heart failure are closely related to cardiac renal function,which can be used as a clinical index to evaluate cardiac renal function in patients with heart failure,and have predictive value for renal dysfunction in hospitalized patients with heart failure.3.Age and high levels of serum NGAL,CRP,UA and BNP are risk factors for CRS in patients with heart failure.