低钠血症与慢性心力衰竭的相关性及预后分析

Correlation of chronic heart failure with hyponatremia and its prognostic analysis

目的分析低钠血症与慢性心力衰竭(CHF)的相关性及预后的关系。方法 CHF住院患者(CHF组)507例及同期非心衰患者(非心衰组)212例,考察2组一般资料情况;将差异有统计学意义的指标为自变量,通过多元Logistic分析血钠与CHF的关系;随访结果分析血钠与CHF患者病死率和再入院率的关系,并进一步分析血钠与脑钠肽(BNP)、左射血分数(LVEF)保留心衰(LVEF≥0.45,HFp EF)和LVEF减低心衰(LVEF<0.45,HFr EF)预后的关系。结果 2组比较,性别、吸烟史等差异无统计学意义(P>0.05),年龄、血红蛋白、血钠等差异有统计学意义(P<0.05);血钠是CHF的保护因素。低钠血症组(Na+<135 mmol/L)BNP浓度高于非低血钠组(P<0.05);LVEF差异无统计学意义。CHF患者中低钠血症组病死率高于非低血钠组(P<0.05),而再入院率差异无统计学意义(P>0.05),HFp EF患者中低钠血症组和非低血钠组病死率及再入院率差异均有统计学意义(P<0.05)。结论血钠是CHF的保护因素,HFp EF合并低钠血症者远期更易死亡及再入院。

Objective To analyze the correlation of hyponatremia with chronic heart failure （CHF） and the prognostic analysis of CHF. Methods Patients with CHF （n=507） and healthy adult （n=212） were included in this study. The general data of the two groups were analysed. The index which was statistically significant was indicated as independent variables. Multivariate logistic analysis was used to analysis the correlation between serum sodium and CHF. The relationship between serum sodium and the prognosis of CHF include mortality and rate of readmission were included in follow-up study. The prognostic correlation of serum sodium with BNP （brain natriuretic peptide）, heart failure with preserved ejection fraction （HFpEF, LVEF≥0.45） and heart failure with reduced ejection fraction （HFrEF, LVEF〈0.45） were all analyzed. Results In- dicators such as sex, smoking history showed no statistical significance between two groups （P 〉 0.05） while other indicators like age, hemoglobin, serum sodium presents statistical significance （P 〈 0.05）. Serum sodium is the protective factor for CHF. Brain natriuretic peptide （BNP） concentration in hyponatremia group is significantly higher than that in normal serum sodium group （P 〈 0.05）. HFpEF and HFrEF were of no significant difference in these two groups. For patients with CHF, the mortality in hyponatremia group is significantly higher than that in normal serum sodium group （P 〈 0.05）, but readmission rates were not significantly different （P 〉 0.05）; While for patients with HFpEF, the mortality and the readmission rates were both significantly different （P 〈 0.05）. Conclusion Serum sodium is the protective factor in CHF, the patients with hypona- tremia have higher readmission rate and death rate in HFpEF background.