血清钾水平与慢性心力衰竭患者病死率的相关性

Correlation between Serum Potassium Level and Mortality in Patients with Chronic Heart Failure

目的探讨血清钾水平与慢性心力衰竭患者病死率的相关性.方法选择2012年1月~ 2015年4月于笔者医院收治的慢性心力衰竭患者183例作为观察组,另选取同期健康体检者64例作为对照组,均测定血脂、血糖、心功能等指标,并应用全自动生化分析仪测定血清钾水平,绘制受试者工作特征曲线(ROC)并计算曲线下面积评价血清钾判断死亡的意义并找出其切点,采用COX回归分析验证判断的准确性,应用多因素Logistic回归分析影响慢性心力衰竭的危险因素.结果观察组与对照组总胆固醇比较,差异无统计学意义(P>0.05),观察组甘油三酯、空腹血糖、左心室舒张末期内径、左心室收缩末期内径显著高于对照组,总蛋白、左心室射血分数、血清钾浓度显著低于对照组(P<0.05);163例患者随访21.28±3.75个月,死亡41例(25.15%),死亡组血清钾浓度显著低于存活组(P<0.05);血清钾水平判断死亡曲线下面积为0.848 (95% CI:0.770 ~0.927,P =0.000),取切点为3.99mmol/L,血清钾水平判断死亡的敏感度、特异性、约登指数分别为89.40%、77.50%、0.669;血清钾水平> 3.99mmol/L的累积生存率明显高于血清钾水平<3.99mmol/L者;甘油三酯、空腹血糖、总蛋白、左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、血清钾水平是影响慢性心力衰竭的危险因素(P均<0.05).结论血清钾与慢性心力衰竭发生、发展密切相关,以3.99mmol/L为切点,具有较高的准确度和特异性,可作为临床诊断与判断预后的重要指标之一.

Objective To explore the correlation between serum potassium level and mortality in patients with chronic heart failure. Methods Totally 183 patients with chronic heart failure treated in our hospital from January 2012 to April 2015 were selected as observation group, and 64 cases of healthy physical examiner were selected as control group in the same period. The indexes of blood lipid, blood glucose and heart function were measured. The serum potassium level was determined by automatic biochemical analyzer. The receiver operating characteristic curve( ROC) was drawn, and the area under the curve was calculated to evaluate the significance of serum potassium in judging death and to find out its cut point. COX regression analysis was used to verify the accuracy of the judgment. Multivariate Logistic regression analysis was used to analyze the risk factors of chronic heart failure. Results There was no significant difference in total cholesterol between the observation group and the control group( P > 0. 05 ). The triglyceride, fasting blood glucose, left ventricular end diastolic diameter and left ventricular end systolic diameter in the observation group were significantly higher than those in the control group. The total protein, left ventricular ejection fraction and serum potassium concentration were significantly lower than those in the control group( P < 0. 05 ). 163 patients were followed up for 21.28 ±3.75 months, and 41 patients(25. 15%) died, serum potassium concentration in the death group was significantly lower than that in the survival group( P < 0. 05 ). The area under curve of serum potassium level in the determination of death was 0. 848(95% CI:0. 770 -0. 927 , P =0. 000). The cut point was 3.99mmol/L. The sensitivity, specificity and Jorden index of serum potassium level was 89. 40%, 77. 50% and 0. 669 respectively. The cumulative survival rate of serum potassium level > 3.99mmol/L was significantly higher than that of serum potassium level < 3.99mmol/L. Triglyceride, fasting blood glucose ,total protein , left ventricular ejection fraction , left ventricular end diastolic diameter, left ventricular end systolic diameter and serum potassium level were risk factors for chronic heart failure( P < 0. 05 ). Conclusion Serum potassium is closely related to the development of chronic heart failure, with 3.99mmol/L as a tangent point, with high accuracy and specificity, which can be used as one of the important indicators for clinical diagnosis and prognosis.