低镁血症对慢性心力衰竭患者院内死亡的影响

Effect of hypomagnesemia on hospital mortality in patients with chronic heart failure

目的探讨住院慢性心力衰竭患者低镁血症发生率对院内死亡心力衰竭的影响。方法回顾性分析2013年1月至2016年12月资料相对完整的1 305例心力衰竭患者,以血清镁浓度<0. 75 mmol/L定义为低镁血症,> 0. 75 mmol/L为非低镁血症。分析心力衰竭患者低镁血症发生率以及对心力衰竭患者院内死亡的影响。结果纳入研究1 305例慢性心力衰竭院内死亡率为7. 8%(103/1 305)。CHF患者的死亡组的心率、心腔内径、射血分数、eGFR、血尿酸、低钠血症、NT-proBNP水平与存活组比较,差异有统计学意义(P <0. 05)。其中66例患者发生低镁血症,发生率为5. 05%(66/1 305),并住院期间死亡37例,死亡率为2. 84%(37/1 305),占总死亡率35. 9%(37/103)。与非低镁血症患者比较,低镁血症患者住院血压水平较低、NYHA心功能分级及N末端B型利钠肽原(NT-proBNP)水平较高(P <0. 01)。Kaplan-Meier生存分析结果显示,低镁血症患者院内心力衰竭死亡风险均明显高于非低镁血症患者(P <0. 01)。多变量Cox比例风险模型分析结果显示,校正多种混杂因素后,入院时低镁血症与心力衰竭患者住院期间心力衰竭可能有相关性。死亡(HR=0. 815,95%CI 0. 704～0. 944,P <0. 05)的独立预测因素。结论除心率、心腔内径、射血分数、eGFR、血尿酸、NT-proBNP水平、低钠血症与存活组间差异有统计学意义外,入院时低镁血症可能是心力衰竭住院患者院内死亡的另一独立预测因素。

Objective To investigate the incidence of hypomagnesia and the impact of in-hospital death on heart failure in hospitalized patients with chronic heart failure. Methods Aretrospective analysis of 1305 cases of heart failure in our hospital from January 2013 to December 2016 was carried out. Defined as hypomagnesia in the serum magnesium concentration 〈0. 75 mmol/L,non hypomagnesia in the serum magnesium concentration 〉0. 75 mmol/L. The incidence of hypomagnesia in patients with heart failure in our hospital and the effect on hospital death in patients with heart failure were analyzed. Results A total of 1 305 cases of chronic heart failure were included in the study,and the in-hospital mortality rate was7. 8%（ 103/1 305）. The heart rate, intracardiac diameter, ejection fraction, eGFR, uric acid,hyponatremia,NT-proBNP level and survival group were significantly different between the CHF patients and the survival group（ P〈0. 05）. The incidence of hypomagnesia was 5. 05%（ 66/1 305）,and 37 cases died during hospitalization,and the mortality rate was 2. 84%（ 37/1 305）,accounting for 35. 9%（ 37/103）. Compared with those with non hypomagnesia,the level of blood pressure in patients with hypomagnesia was lower,NYHA cardiac function classification and the level of N terminal B type natriuretic peptide（ NT-proBNP） were higher（ P〈0. 01）. Kaplan-Meier survival analysis showed that the risk of death in patients with hypomagnesia significantly higher than that in patients with non hypomagnesia（ P〈0. 01）. The multivariate Cox proportional risk model analysis showed that after the correction of a variety of Confounding factor,hypomgma at admission may be associated with heart failure during heart failure patients. The independent predictors of death（ HR = 0. 815,95% CI 0. 704-0. 944,P〈0. 05）.Conclusions The difference of heart rate,inner diameter of heart cavity,ejection fraction,eGFR,serum uric acid,NT-proBNP level,hyponatremia and survival group was significant,and hypomagnesia at admission may be another independent predictor of hospital death in patients with heart failure.