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Objective: To study the congestive heart failure (Congestive heart failure, CHF) in patients with brain natriuretic peptide (Brain natriuretic peptide, BNP) concentration changes in NYHA class characteristics and changes under the classification of renal characteristics, and to explore its the The relationship between. Methods: 283 cases of CHF patients in our hospital outpatient and inpatient treatment, in accordance with the New York Heart Association (NYHA) functional classification scheme developed heart included. Determination of each sample serum creatinine, BNP concentration and the estimated value of the glomerular filtration rate (Estimated glomerular filtration rate, eGFR) calculated according to Cockroff-Gault formula. Divided into four groups to compare the sample standard according to the NYHA functional class (NYHA I ~ IV); renal grading standards (in eGFR of ≥ 90,60 ≤ eGFR lt; to 90,40 ≤ eGFR lt; 60, the eGFR lt; 40) The samples were also divided into four groups for comparison; according to whether the renal damage (eGFR ≥ 60, eGFR lt; 60) will be divided into two groups to compare sample. BNP levels compare different causes, different level of heart function, kidney function level, heart and kidney function classification state their relationship. Results: 1. Different causes BNP concentration comparing coronary heart disease (group 1), DCM (group 2), hypertension (group 3), rheumatic heart disease (group 4), congenital heart disease (group 5) five groups BNP levels were 233.8 ± 89.4 pg / ml, 285.3 ± 112.4 pg / ml, 258.5 ± 100.4 pg / ml, 217.6 ± 110.4 pg / ml, 296.9 ± 167.5 pg / ml. BNP concentration difference between the five groups without statistical significance (P gt; 0.05). The comparison in NYHA functional class BNP concentrations NYHAI (group 1), the NYHAII (group 2), NYHAIII (group 3), NYHAIV four groups (Group 4), BNP concentrations were 45.3 ± 11.1 pg / ml, 69.3 ± 18.2 pg / ml, 145.6 ± 49.9 pg / ml, 322.5 ± 101.1 pg / ml. Elevated BNP levels with NYHA class increased between four groups differences were statistically significant (P lt; 0.01) renal grade BNP concentrations affect the comparison in in eGFR of ≥ 90 (group 1) 60 ≤ eGFR lt; 90 (group 2), 40 ≤ eGFR lt; 60 (group 3), the eGFR lt; 40 (group 4) four groups, BNP levels were 109.4 ± 71.0 pg / ml, 154.7 ± 110.0 pg / ml, 227.8 ± 161.3 pg / ml, 281.4 ± 176.5 pg / ml. BNP levels increased with decreasing eGFR of differences between the four groups were statistically significant (P lt; 0.01) 4. Heart and kidney function grading BNP concentration ① according to the heart, renal grading samples are divided into 16 groups, namely: NYHAI level and eGFR ≥ 90 groups, NYHAII eGFR ≥ 90 groups, NYHAIII eGFR ≥ 90 groups, NYHAIV eGFR ≥ 90 groups, NYHAI level and 60 ≤ eGFR lt; 90 groups, NYHAII and 60 ≤ eGFR lt; 90 group NYHAIII level and 60 ≤ eGFR lt; 90 group, NYHAIV 60 ≤ eGFR lt; 90, NYHAI and 40 ≤ eGFR lt; 60 Group, NYHAII-level and 40 ≤ eGFR lt; 60 group, NYHAIII 40 ≤ eGFR lt; 60 groups, NYHAIV level and 40 ≤ eGFR lt; 60, NYHAI level and eGFR lt; 40, NYHAII level and eGFR lt; 40 group, NYHAIII level and eGFR lt; 40, NYHAIV and eGFR lt; 40 group. Analysis of NYHA class and renal function serum BNP levels. The ② results: BNP concentration in NYHA class and renal function classification under a double standard BNP concentration changes characteristics not only with changes in the degree of NYHA class, and also subject to the grading of renal (P lt; 0.01). With NYHA class increased in the same level of renal BNP increased (P lt; 0.01); same NYHA class, with the kidney function is getting worse, serum BNP levels gradually level significantly higher (P lt; 0.01), and this trend is more obvious in patients with more severe NYHA class. Patients in NYHA IV class heart function, eGFR lt; groups of 40 patients with serum BNP levels can be achieved the same NYHA levels of eGFR ≥ 90 groups of 2 to 2.5 times. Spearman rank correlation analysis results due to serum BNP concentration of non-normal distribution, during the regression model is used as ㏒ BNP value of serum BNP concentration value. NYHA eGFR, LVEF, LVEDd age and ㏒ BNP presence of correlation, and correlation between size and LogBNP: NYHA (rs = 0.621, P lt; 0.0001) gt; LVEF (rs = -0.781, P lt; 0.0001 ) for gt; LVEDd (rs = 0.409, P lt; 0.0001) gt; eGFR (rs = -0.363, P lt; 0.0001) gt; age (rs = 0.246, P lt; 0.0001). The correlation of Gender and LogBNP not significant (rs = -0.056, P = 0.196). 6. Multivariate stepwise regression results ㏒ the BNP as the dependent variable as independent variables, age, gender, NYHA, eGFR, LVEF and LVEDd line multivariate stepwise regression. Setting P enters = 0.05, P removed = 0.10. Final four variables into the equation: NYHA (X1), eGFR (X2), LVEF (X3), LVEDd (X4), which can be drawn from the \3.069 0.563X1 of-the 0.32X2-0.06X3-0.33X4 ㏒ the BNP value changes with NYHA, LVEDd, eGFR, LVEF linear regression, which is positively correlated with NYHA negatively correlated with LVEDd, eGFR, LVEF. With normal renal function and impaired renal function group BNP concentration in NYHAI level samples in eGFR of ≥ 60 group and eGFR lt; 60 group BNP concentration were 41.8 ± 10.4pg/ml, 54.0 ± 7.2pg/ml ( P lt; 0.01); NYHAII grade samples in eGFR of ≥ 60 and eGFR lt; 60 group BNP concentrations were 62.5 ± 17.7pg/ml,, 79.9 ± 13.3pg/ml (P lt; 0.01); in NYHAIII class sample in eGFR ≥ 60 group, and eGFR lt; the 60 group BNP levels were 125.2 ± 29.2pg/ml, 217.6 ± 40.3pg/ml (P lt; 0.01); in NYHA IV grade samples in eGFR of ≥ 60 and eGFR lt; 60 group BNP concentrations were 249.1 ± 67.1pg/ml, 416.3 ± 41.8pg/ml (P lt; 0.01). Conclusion: 1. Between renal function and serum BNP levels were correlated, and with the severity of impaired renal function, serum BNP levels gradually increased. In same the NYHA-level groups in serum BNP levels in patients with impaired renal function was significantly higher, and in determining the degree of heart failure in this group, the critical value of BNP's should be a corresponding increase 3. Clinical , very common in patients with heart failure with impaired renal function, eGFR indicators obtained very fast, simple and spend less. This has important practical value for guiding us to a comprehensive analysis of the patient's condition.
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