血清钠水平对急性ST段抬高型心肌梗死患者近期预后的预测价值

The Early Prognostic Value of Serum Sodium Level in Patients With Acute ST-elevation Myocardial Infarction

目的:探讨血清钠(Na^+)水平与急性ST段抬高型心肌梗死(STEMI)患者近期预后的关系。方法:回顾性分析符合欧洲心脏病学会和美国心脏病学会诊断标准,发病12 h内的STEMI患者7 461例,根据患者入院24 h内血清Na^+水平最低值将患者分为≥135 mmol/L组、130~134 mmol/L组、<130 mmol/L组,比较各组间基线信息、30天死亡等主要不良事件发生率以及神经内分泌抑制治疗效果的差异并分析其与血清Na^+水平的关系。结果:<130 mmol/L组7天和30天死亡率较其他两组高(P均<0.001);<130 mmol/L组与≥135 mmol/L组相比,30天心原性休克、心力衰竭和危及生命的心律失常发生率也显著升高(P<0.001)。校正了年龄、利尿剂治疗及再灌注治疗等其他影响因素后,血清Na^+<130 mmol/L依然与7天及30天死亡显著相关(OR分别为1.69及1.57)。单变量和多变量分析均显示出血清Na^+<130 mmol/L与心原性休克(OR分别为1.75及1.64)、心力衰竭(OR分别为1.42及1.30)和危及生命的心律失常(OR分别为1.53及1.34)等次要终点事件显著相关。三组患者中,无论单独应用血管紧张素转换酶抑制剂或β受体阻滞剂,还是联合应用两种药物治疗,与未使用这类药物的患者相比30天死亡率均明显降低(P均<0.001);<130 mmol/L组患者下降幅度较其他两组更为显著,差异有统计学意义(P<0.001)。结论:入院24 h内的血清Na^+<130mmol/L是STEMI患者近期死亡、心原性休克、心力衰竭和危及生命的心律失常等主要不良事件的危险因素。

Objective： To explore the relationship between serum sodium level and early prognosis in patients with acute ST- elevation myocardial infarction （STEMI）. Methods： A total of 7461 STEMI patients within 12h of onset who matched the diagnostic standard of European society of cardiology and American college of cardiology were retrospectively studied. According to serum sodium levels within 24h of admission, the patients were categorized into 3 groups： Serum sodium≥135 mmol/L group, Serum sodium 130-134 mmol/L group and Serum sodium〈130 mmol/L group. The baseline condition, 30-day mortality with other adverse events and the effect of neuroendocriology inhibitor treatment were compared among 3 groups; their relationships to serum sodium level were analyzed. Results： Serum sodium〈130 mmol/L group had the higher 7-day and 30-day mortality than the other 2 groups, both P〈0.001; compared with Serum sodium〉135 mmol/L group, Serum sodium〈130 mmol/L group presented the higher occurrence rates of 30-day cardiac shock, heart failure （HF） and life-threatening arrhythmia, P〈0.001. With adjusted affecting factors of age, diuretic and reperfusion treatments, serum sodium〈130 mmol/L was still related to 7-day and 30-day mortality （OR=1.69 and OR=1.57）. Both single and multivariable analysis indicated that serum sodium〈130 mmol/L was related to cardiac shock （OR=1.75 and OR=1,64）, HF （OR=1.42 and OR=1.30） and life-threatening arrhythmia （OR=1.53 andOR= 1.34）. In all 3 groups, the patients using ACE inhibitor, 13-blocker or both medications had reduced 30-day mortality than those without such medication, all P〈0.001; the reduction was more obvious in Serum sodium〈130 mmol/L group than the other 2 groups, P〈0.001. Conclusion： Serum sodium level〈130 mmol/L within 24h of admission was the risk factor for the early stage main adverse events as mortality, cardiac shock, HF and life-threatening arrhythmia in acute STEMI patients.