血清钠离子在老年女性急性心力衰竭患者30天主要不良心血管事件中的预测价值

Value of serum sodium for predicting incidence of MACE in elderly female AHF patients at different time points during 30-day follow-up period

目的探讨老年女性急性心力衰竭(心衰)患者不同时间点血清Na+与30 d主要不良心血管事件(MACE)的关系。方法选择老年女性急性心衰患者120例,根据心衰发作时Na+水平按33.3%,66.7%分位数由低到高分为T1组39例(Na+<140 mmol/L),T2组42例(140 mmol/L≤Na+<142.5 mmol/L),T3组39例(Na+≥142.5 mmol/L)。分析不同程度Na+与30 d MACE的相关性。比较心衰发作时、心衰发作后48 h及7 d血清Na+对MACE的预测价值。结果利用Kaplan-Meier生存曲线,随访30 d,T1组MACE发生率明显高于T2组与T3组(Plog rank=0.016)。Spearman相关性分析显示,心衰发作时Na+与LVEF呈正相关,与左心室收缩末期容积呈负相关(P<0.01)。心衰发作时Na+是老年女性急性心衰患者30 d MACE的独立预测因素(P<0.05)。ROC曲线分析显示,心衰发作时血清Na+的ROC曲线下面积为0.745(95%CI:0.621~0.869,P=0.003),最佳临界值为138.1 mmol/L,敏感性64.3%,特异性79.8%。结论老年女性心衰急性发作时,血清Na+与30 d MACE相关。

Objective To study the relationship between serum Na+and incidence of MACE in elderly female acute heart failure(AHF)patients at different time points during the 30-day follow-up period.Methods One hundred and twenty elderly female AHF patients were divided into T1(Na+<140 mmol/L)group(n=39),T2(140 mmol/L≤Na+<142.5 mmol/L)group(n=42)and T3(Na+≥142.5 mmo/L)group(n=39).The relationship between serum Na+and incidence of MACE in elderly female AHF patients at different time points during the 30-day follow-up period was analyzed.The value of serum Na+for predicting the incidence of MACE at onset of HF,at 48 h and on day 7 after onset of HF was compared.Results The incidence of MACE was significantly higher in T1 group than in T2 group and T3 group at different time points during the 30-day follow-up period(Plog rank=0.016).Spearman correlation analysis displayed that serum Na+was positively related with LVEF and negatively related with LVESV at onset of HF(P<0.01).Multivariate logistic regression analysis revealed that serum Na+was an independent predictor for the incidence MACE in elderly female AHF patients at onset of HF(P<0.05).ROC curve analysis indicated that the AUC for serum Na+for predicting the incidence of MACE in elderly female AHF patients at onset of HF was 0.745(95%CI:0.621-0.869,P=0.003)with a cut-off value of 138.1 mmol/L,a sensitivity of 64.3%,a specificity of 79.8%.Conclusion Serum Na+is related with the incidence of MACE in elderly female AHF patients at onset of HF.