射血分数降低的急性心力衰竭患者血清钠离子对病情严重程度及预后的评估价值

doi:10.3760/cma.j.issn.1007-1245.2023.16.020

摘要/Abstract

摘要：

目的　探讨射血分数降低的急性心力衰竭患者血清钠离子对病情严重程度及预后的评估价值。方法　选取2020年1月至2022年1月聊城市第三人民医院收治的120例射血分数降低的急性心力衰竭患者为研究对象，其中男性73例，女性47例，年龄62～81（69.17±4.36）岁。所有患者均进行血清钠离子水平检测和心功能检查，比较不同心功能分级患者的血清钠离子水平和左心室射血分数（LVEF），分析血清钠离子与心功能分级、LVEF的相关性。随访所有患者6个月，以全因死亡或不良心血管事件为观察终点分为预后不良组和预后良好组，比较两组临床特征，并采用logistic回归分析预后影响因素。结果　Ⅱ级、Ⅲ级、Ⅳ级心功能患者的血清钠离子水平分别为（128.64±8.34）mmol/L、（117.34±10.05）mmol/L、（104.13±10.56）mmol/L，差异均有统计学意义（均P<0.05）。Ⅱ级、Ⅲ级、Ⅳ级心功能患者的LVEF分别为（39.46±3.73）%、（33.19±5.58）%、（28.69±5.21）%，差异均有统计学意义（均P<0.05）。相关性分析结果显示，血清钠离子与心功能分级呈负相关（r=-0.644，P<0.05），与LVEF呈正相关（r=0.395，P<0.05）。随访所有患者6个月，以全因死亡或不良心血管事件为观察终点，预后不良一共37例，预后良好一共83例。单因素分析结果显示，预后不良组和预后良好组患者年龄、心功能分级、LVEF、高血压、糖尿病、钠离子水平、服用利尿剂比较，差异均有统计学意义（均P<0.05）。logistic回归分析显示，校正年龄、心功能分级、LVEF、高血压、糖尿病后，两组患者血清钠离子水平差异仍有统计学意义（OR=0.589，95%CI 0.264～0.903，P<0.05）。绘制受试者工作特征曲线分析显示，钠离子对急性心力衰竭患者预后具有显著的预测价值（曲线下面积=0.822，95%CI 0.744～0.899）。结论　血清钠离子水平可作为评估射血分数降低的急性心力衰竭患者病情严重程度和预后的有效指标。

关键词:

急性心力衰竭, 射血分数降低, 血清钠离子, 心功能, 预后

Abstract:

Objective　To explore the value of serum sodium ion in evaluating the severity and prognosis of patients with acute heart failure and decreased ejection fraction. Methods　From January 2020 to January 2022, 120 patients with acute heart failure and decreased ejection fraction treated in Liaocheng Third People's Hospital were selected as the study objects, including 73 males and 47 females. They were 62-81 (69.17±4.36) years old. All the patients' serum sodium level and cardiac function were detected. The serum sodium levels and left ventricular ejection fractions (LVEF) of the patients with different concentric function grades were compared. The correlations between serum sodium level and cardiac function grades and LVEF were analyzed. All the patients were followed up for six months, and were divided into a poor prognosis group and a good prognosis group; all-cause death or adverse cardiovascular events were set as the observation endpoint. The clinical characteristics of the two groups were compared. The prognostic factors were analyzed by logistic regression. Results　The levels of serum sodium in the patients with grade Ⅱ, Ⅲ, and Ⅳ cardiac function were (128.64 ± 8.34) mmol/L, (117.34 ± 10.05) mmol/L, and (104.13 ± 10.56) mmol/L, respectively, with statistical differences (all P<0.05). The LVEF of the patients with grade Ⅱ, Ⅲ, and Ⅳ cardiac function were (39.46±3.73)%,(33.19±5.58)%, and (28.69±5.21)%, respectively, with statistical differences (all P<0.05). The results of correlation analysis showed that serum sodium was negatively correlated with cardiac function grading (r=-0.644, P<0.05), and positively with LVEF (r=0.395, P<0.05). All the patients were followed up for 6 months; all-cause death or adverse cardiovascular events were set as the end point; 37 patients had poor prognosis and 83 patients had good prognosis. The results of univariate analysis showed that there were statistical differences in age, cardiac function grade, LVEF, hypertension, diabetes, sodium ion level, and diuretics between the poor prognosis group and the good prognosis group (all P<0.05). Logistic regression analysis showed that after adjusting the age, cardiac function grade, LVEF, hypertension, and diabetes, there was still a statistical difference in the serum sodium level between the two groups (OR=0.589,95%CI 0.264-0.903,P<0.05). The receiver operating characteristic curve analysis showed that sodium ion had significant predictive value for the patients' prognosis (the area under the curve=0.822, 95% CI 0.744-0.899). Conclusion　Serum sodium level can be used as an effective indicator in evaluating the severity and prognosis of patients with acute heart failure and decreased ejection fraction.

Key words:

Acute heart failure, Decreased ejection fraction, Serum sodium ion, Cardiac function, Prognosis

朱亚明刘合莲.

射血分数降低的急性心力衰竭患者血清钠离子对病情严重程度及预后的评估价值 [J]. 国际医药卫生导报, 2023, 29(16): 2306-2310.

Zhu Yaming, Liu Helian.

Serum sodium ion in evaluation of severity and prognosis in patients with acute heart failure and decreased ejection fraction [J]. International Medicine and Health Guidance News, 2023, 29(16): 2306-2310.

参考文献

[1] 邱伯雍. 慢性心力衰竭流行病学及防治研究进展[J]. 中华实用诊断与治疗杂志,2017,31(6):619-621. DOI:10.13507/j.issn.1674-3474.2017.06.032.
[2] 林家聪,林明强,吕有凯,等. 急性心力衰竭伴肾功能不全老年患者血清NT-proBNP水平检测的价值[J]. 内科急危重症杂志,2017,23(6):507-508,518. DOI:10.11768/nkjwzzzz20170620.
[3] 邵淑梅. BNP、NT-proBNP、CysC与射血分数保留心力衰竭的相关性研究[D]. 延安: 延安大学, 2019.
[4] 王力,王传合,韩苏,等. 血清钠离子水平与慢性心力衰竭患者院内死亡的关系[J]. 中国医师进修杂志,2022,45(2):148-151. DOI:10.3760/cma.j.cn115455-20210528- 00708.
[5] 边圆,王甲莉,程凯,等. 2016年欧洲心脏病学会急性心力衰竭指南解读[J]. 中华急诊医学杂志,2016,25(7):849-853. DOI:10.3760/cma.j.issn.1671-0282.2016.07.001.
[6] 武效宏,王小冬,李国然,等. 慢性心力衰竭发生低钠血症相关因素及对预后的影响研究[J]. 人民军医,2021,64(4):343-347. DOI:10.3969/j.issn.1000-9736.2021.04.017.
[7] Vaduganathan M, Greene SJ, Ambrosy AP, et al. Relation of serum uric acid levels and outcomes among patients hospitalized for worsening heart failure with reduced ejection fraction (from the efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan trial) [J]. Am J Cardiol, 2014, 114(11): 1713-1721. DOI: 10.1016/j.amjcard.2014.09.008.
[8] 祁昊.慢性心力衰竭合并低钠血症的发病因素分析[J].中国医学工程,2021,29(3):94-96.
[9] 刘海浪,林振宇,张媛媛,等. 入院时低钠血症对老年射血分数保留型心力衰竭患者预后评估的价值[J]. 中国心血管病研究,2021,19(4):294-299. DOI:10.3969/j.issn. 1672-5301.2021.04.02.
[10] Shchekochikhin DY, Schrier RW, Lindenfeld J, et al. Outcome differences in community- versus hospital-acquired hyponatremia in patients with a diagnosis of heart failure [J]. Circ Heart Fail, 2013, 6(3):379-386. DOI: 10.1161/CIRCHEARTFAILURE.112.000106.
[11] 张宇,李新,冷晓,等. 不同血清钠离子水平对高龄心力衰竭患者心功能和预后的影响[J]. 中华老年医学杂志,2018,37(9):962-965. DOI:10.3760/cma.j.issn.0254-9026. 2018.09.002.
[12] 王钰,张英杰. 血清钠离子浓度联合红细胞比容对急性心力衰竭短期预后的预测价值[J]. 中国临床医学,2021,28(5):874-878. DOI:10.12025/j.issn.1008-6358.2021. 20202636.
[13] Davison BA, Metra M, Senger S, et al. Patient journey after admission for acute heart failure: length of stay, 30-day readmission and 90-day mortality [J]. Eur J Heart Fail, 2016, 18(8): 1041-1050. DOI: 10.1002/ejhf.540.
[14] Hiki M, Kasai T, Yatsu S, et al. Relationship between serum sodium level within the low-normal range on admission and long-term clinical outcomes in patients with acute decompensated heart failure [J]. Int Heart J, 2018, 59(5): 1052-1058. DOI: 10.1536/ihj.17-524.
[15] 马乔娟,刘超,张军,等. 急性失代偿性心力衰竭患者血清钠离子和尿酸水平对短期预后的预测价值[J]. 中国心血管杂志,2018,23(6):473-476. DOI:10.3969/j.issn.1007-5410. 2018.06.009.