急性心肌梗死低钠血症的预后价值

The prognostic value of hyponatremia in patients with acute myocardial infarction

目的探讨急性心肌梗死（AMI）低钠血症的预后价值。方法对我院心内科CCU病房2003年1月至2004年12月670例资料完整的AMI患者进行了回顾性分析，根据患者入院后即刻、24、48h血清钠离子浓度最低值共分为三组：A组Na^＋≥135mmol／L；B组Na^＋ 120—135mmoL／L；C组Na^＋≤120mmol／L。比较各组心肌酶、心肌梗死面积、心功能及住院病死率。结果（1）三组住院病死率分别为：A组7．6％（17／225），B组8．1％（34／421），C组33．3％（8／24），C组分别与A组和B组比较，差异具有统计学意义（P〈0．05）。（2）三组肌酸激酶（CK），肌酸激酶同工酶（CK-MB）及心肌梗死面积（S）进行比较，C组分别与A组和B组比较差异有统计学意义（P〈0．05）。（3）住院期间死亡59例，存活611例，存活组与死亡组血清钠离子浓度分别为（133．00±5．25）mmoVL和（122．00±7．25）mmol／L，两组比较差异有统计学意义（P〈0．01）。（4）对AMI后30天住院期间死亡危险因素进行多因素logistic回归分析，血清钠离子浓度降低与AMI后30天住院期间病死率相关。并且30天住院期间病死率随着血清钠离子浓度降低而升高。

Objective To evaluate the prognostic significance of hyponatremia in patients with AMI. Methods The study population consisted of 670 patients with AMI in coronary care unit in our hospital from January 2003 to December 2004. The patients were designed into three groups according to serum sodium concentration within twenty four to forty eight hours following the onset of AMI： Group A. Na~ 135 mmol/L; Group B. Na^＋ 120-135 mmol/L;Group C. Na^＋ ≤120 mmol/L The data of myocardial enzymes, myocardial infarction size, heart function and inhospital mortality were analyzed retrospectively. Results 1. The inhospital mortality of each group ： group A was 7. 6% （ 17/225 ） , group B was 8. 1% （34/421） ,group C was 33.3% （8/24）. The difference between group C and group B or group A was significant The P value was little than 0. 05. 2. Activities of serum creatine phosphatase kinase and serum creatine phosphatase kinase isoenzymes and myocardial infarction sizes in each group were different （P〈0.05）. 3. 59 cases of all died and 611 cases of all recovered in duration of hospital stay. Serum sodium concentrations of the recovered group were（ 133.00 ~ 5.25）mmol/L, and that of the died group were （ 122. 00 ＋ 7.25 ） mmol/L（ P 〈 0. 01 ）. 4. In a multivariate logistic regression analysis, hyponatremia was associated with 30-day mortality in patients with AMI. In analysis of the association between the degree of hyponatremia and outcome, we observed that the risk of 30-day mortality increased with the severity of hyponatremia. Conclusion Hyponatremia may be one of the important markers that predict a worse prognosis in patients with AMI.