低钠血症与急性ST段抬高型心肌梗死患者近期预后相关性

Short-term prognostic impact of hyponatremia on the patients with acute ST-elevation myocardial infarction

目的探讨低钠血症与急性ST段抬高型心肌梗死（STEMI）患者近期预后的相关性。方法选取2014年3月至2015年5月至郑州大学第一附属医院心血管内科收治的急性ST段抬高型心肌梗死患者223例，测定患者入院时、入院后48h、入院后72h血清钠离子浓度，低钠血症定义为血清钠离子浓度〈135mmol／L，根据患者血钠浓度将所有入选患者分为血钠正常组、入院时低钠血症组、入院后72h内发生低钠血症组，观察患者入院30d内心源性休克、死亡、急性肾功能衰竭、室壁瘤形成及室间隔穿孔等不良事件发生率，并进行相关性及回归分析。结果与血钠正常组相比，低钠血症组患者病死率较高（P〈0．01），更易合并心源性休克（P〈0．01）、急性肾功能衰竭（P〈0．01）、室壁瘤形成（P=0．005）等不良事件；30d的病死率与低钠血症的严重性呈正相关（与血钠正常组相比，血钠水平130～134mmol／L死亡风险OR值2．0（95％CI：1．1—3．4；P=0．006），血钠水平〈130mmol／L死亡风险OR值3．3（95％CI：1．4—7．7；P=0．003）。结论入院时或入院早期发生低钠血症是急性ST段抬高型心肌梗死患者近期病死率的独立危险因素，且预后与低钠血症严重性呈正相关。

Objective To investigate the correlation between hyponatremia and short-term prognostic impact of acute ST-elevation myocardial infarction. Methods Two hundred and twenty-three con- secutive patients with aetute ST-elevation myocardial infarction from March 2014 to May 2015 were selected. Plasma sodium concentrations were obtained at 24,48,72 hours. Hyponatremia defined as a plasma sodium level 〈 135 mmol/L. According to the plama soudium level, patients were divided into three groups （normal sodium level, hyponatremia on admission, hyponatremia within 72 hours）. Results Compared with normal sodium level group, the fatality of hyponatremia group was higher（ P 〈 0. 01 ）, and was more often to had cardiac shock, acute renal disfunction, left ventricular aneurysm. The risk of 30 day fatality increased with the severity of hyponatremia. Conclusions Hyponatremia on admission or early development of hyponatremia in patients with acute ST-elevation myocardial infarction is an independent predictor of 30 day fatality, and prognosis worsens with the severity of hyponatremia.