基于倾向性评分匹配法评估钠离子浓度对心力衰竭患者预后的影响

Prognostic Effect of Sodium Concentration in Patients with Heart Failure Based on Propensity Score Matching

目的探讨低钠血症是否为心力衰竭(简称心衰)患者不良预后的独立危险因素。方法连续纳入2015年1月至2017年12月在我院接受治疗的心衰患者1 589例作为研究对象。按入院时是否存在低钠血症分为低钠血症组(n=207)和非低钠血症组(n=1 382),平均钠离子浓度(139±4.4) mmol/L。通过倾向性匹配法进行分组,以出院后1年内的全因死亡为主要终点事件,通过基线对比及Cox回归分析研究低钠血症是否为其不良预后独立危险因素。结果与非低钠血症组相比,低钠血症组纽约心功能分级(NYHA)较差,高血压患者数更少,收缩压、舒张压、左心室射血分数(LVEF)、血红蛋白、白蛋白、低密度脂蛋白(LDL)偏低,但心率、脑钠肽(BNP)、尿素氮、肌酐、伴随瓣膜病比例高于非低钠血症组。在用药方面,低钠血症组使用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)、β受体阻滞剂、螺内酯的比例要低于非低钠血症组。Cox多因素分析结果提示,低钠血症组患者1年内全因死亡风险增加85.7%(HR=1.857,95%CI:1.053,3.274,P=0.032)。倾向性匹配法重新分组后,低钠血症仍为心衰患者不良预后的独立预测因子,全因死亡风险增加28%(HR=1.280,95%CI:1.006,1.428,P=0.044)。结论经过倾向性匹配法重新分组,低钠血症为心衰患者不良预后的独立危险因素。

Objective To investigate whether hyponatremia is an independent poor prognostic factor in patients with heart failure.Methods We enrolled a total of 1 589 patients who were admitted for heart failure from January 2015 to December 2017,with 207 patients categorized into the hyponatremia group and 1 382 patients categorized into the non-hyponatremia group(sodium concentration,139±4.4 mmol/L). Propensity score matching at baseline and Cox regression analysis were performed,and the primary endpoint was allcause mortality within 1 year after discharge. Results Compared with the non-hyponatremia group,the hyponatremia group had worse New York Heart Association grade;included fewer patients with hypertension;had lower systolic/diastolic blood pressure,left ventricular ejection fraction,hemoglobin,albumin,and low-density lipoprotein;had higher heart rate,brain natriuretic peptide,blood urea nitrogen,and creatinine;and included more patients with valvular disease. In terms of medications,the hyponatremia group used less angiotensin-converting enzyme inhibitors/angiotensin receptor blockers,β-blockers,and spironolactones. The results of Cox multivariate analysis suggested that patients with hyponatremia had an 85.7% increased risk of all-cause mortality within 1 year [hazard ratio(HR)=1.857,95% confidence interval(CI):1.053,3.274,P = 0.032)]. When propensity score matching was done,the risk of all-cause mortality increased by 28%(HR=1.280,95% CI:1.006,1.028,P = 0.044). Conclusion After re-grouping with propensity score matching,hyponatremia is an independent poor prognostic factor in patients with heart failure.