老年心力衰竭患者低钠血症与其预后相关性研究

Correlation between hyponatremia and prognosis in elderly patients with heart failure

目的分析老年心力衰竭(心衰)患者低钠血症与其预后的相关性,旨意为相关人员的研究工作提供参考。方法80例60岁以上老年心衰患者,将入院时血钠值<135 mmol/L视为低钠血症,以此为基准,将患者分为非低钠组(44例)和低钠组(36例)。比较两组患者临床资料[基础疾病、美国纽约心脏病学会(NYHA)分级、收缩压(SBP)、舒张压(DBP)、心率、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、白蛋白、血红蛋白、血尿素、肌酐],血管紧张素、血浆肾素、醛固酮水平,用药详情,病死率以及住院时间;分析老年心衰患者病死率及住院时间的相关性。结果低钠组患者NYHA分级Ⅳ级23例、SBP 126(111,151)mm Hg(1 mm Hg=0.133 kPa)、DBP 78(71,81)mm Hg、LVEF 43(36,53)%、白蛋白37.1(33.6,40.1)g/L、血红蛋白128.6(113.2,142.5)g/L、血尿素7.9(5.6,11.4)mmol/L与非低钠组的18例、136(121,151)mm Hg、81(71,91)mm Hg、49(40,58)%、38.2(35.5,41.1)g/L、132.2(118.2,114.2)g/L、7.0(5.3,9.4)mmol/L比较,差异具有统计学意义(P<0.05);两组基础疾病、心率、LVEDD、肌酐水平比较,差异均无统计学意义(P>0.05)。低钠组血浆肾素1.02(0.36,4.36)μg/L、血管紧张素67.6(48.8,99.5)ng/L、醛固酮116.6(75.6,188.6)ng/L均高于非低钠组的0.43(0.11,1.38)μg/L、54.5(38.8,78.9)ng/L、97.6(68.6,141.5)ng/L,差异具有统计学意义(P<0.05)。非低钠组使用硝酸甘油酯类药物、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)药物、β-受体阻滞药物、钙通道阻滞药物占比分别为80.6%、61.1%、16.7%、16.7%,均低于非低钠组的95.5%、81.8%、38.6%、36.4%,使用洋地黄、利尿剂占比均为72.2%,均高于非低钠组的61.4%、59.1%,差异具有统计学意义(P<0.05)。所有患者的中位住院时间为13 d,全因病死率为11.25%(9/80)。非低钠组住院时间13(9,19)d短于低钠组的15(9,23)d,低钠组全因病死率为19.44%(7/36),高于非低钠组的4.55%(2/44),差异具有统计学意义(P<0.05)。患者的主要死亡原因为心衰。多因素回归分析结果显示:NYHA分级、左心室收缩功能、肌酐值、SBP、血钠值均为老年心衰患者住院病死的危险因素(P<0.05)。多元线性回归结果显示:老年心衰患者血尿素值、尿酸值、SBP、血钠值与住院时间均具有相关性(P<0.05)。患者入院时血钠每降低3 mmol/L,患者住院病死率增加27.00%,其中当患者血钠<140 mmol/L时,住院病死率和血钠为负相关关系(r=-0.477,P<0.05)。当血钠>140 mmol/L时,其与住院时间呈正相关关系(r=0.609,P<0.05)。结论老年心衰患者合并低钠血症的几率较高,其存在住院病死率高、住院时间长、神经激素活性程度高、心脏功能不佳的情况,使用有效方式积极预防心衰患者出现低钠血症,对于减少住院时间、促进患者疾病转归意义重大。

Objective To analyze the correlation between hyponatremia and prognosis in elderly patients with heart failure,so as to provide reference for the research work of related personnel.Methods 80 elderly heart failure patients over 60 years of age were selected,the blood sodium value of<135 mmol/L at admission was considered as hyponatremia.Based on this,all patients were divided into non-hyponatremia group(44 cases)and hyponatremia group(36 cases).Both groups were compared in terms of clinical data[underlying disease,New York Heart Association(NYHA)grading,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate,left ventricular end-diastolic internal diameter(LVEDD),left ventricular ejection fraction(LVEF),albumin,hemoglobin,blood urea nitrogen,creatinine],angiotensin,plasma renin,aldosterone,details of medication use,mortality rate,and length of hospital stay.The correlation of mortality with length of hospital stay in elderly patients with heart failure was analyzed.Results In hyponatremia group,23 cases were in NYHA gradeⅣ,SBP was 126(111,151)mm Hg(1 mm Hg=0.133 kPa),DBP was 78(71,81)mm Hg,LVEF was 43(36,53)%,the albumin was 37.1(33.6,40.1)g/L,the hemoglobin was 128.6(113.2,142.5)g/L,the blood urea nitrogen was 7.9(5.6,11.4)mmol/L,which were lower than those of 18 cases,136(121,151)mm Hg,81(71,91)mm Hg,49(40,58)%,38.2(35.5,41.1)g/L,132.2(118.2,114.2)g/L,7.0(5.3,9.4)mmol/L in the non-hyponatremia group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in underlying diseases,heart rate,LVEDD and creatinine levels between the two groups(P>0.05).In hyponatremia group,the plasma renin was 1.02(0.36,4.36)μg/L,the angiotensin was 67.6(48.8,99.5)ng/L and the aldosterone was 116.6(75.6,188.6)ng/L,which were higher than those of 0.43(0.11,1.38)μg/L,54.5(38.8,78.9)ng/L and 97.6(68.6,141.5)ng/L in non-hyponatremia group,and the differences were statistically significant(P<0.05).The proportions of nitroglycerides,agiotensin converting enzyme inhibitors/angiotensin receptor blockers(ACEI/ARB),β-receptor blockers and calcium channel blockers in non-hyponatremia group were 80.6%,61.1%,16.7%and 16.7%,which were lower than those of 95.5%,81.8%,38.6%and 36.4%in non-hyponatremia group;the proportion of digitalis and diuretics in hyponatremia group was 72.2%,which was higher than those of 61.4%and 59.1%in non-hyponatremia group;the difference were statistically significant(P<0.05).The median length of hospital stay for all patients was 13 d,and the all-cause fatality rate was 11.25%(9/80).The length of hospital stay of 13(9,19)d in the non-hyponatremia group was shorter than that of 15(9,23)d in the hyponatremia group;the all-cause fatality rate of was 19.44%(7/36)in hyponatremia group was higher than that of 4.55%(2/44)in non-hyponatremia group;the differences were statistically significant(P<0.05).The main cause of death was heart failure.Multivariate regression analysis showed that NYHA grading,left ventricular systolic function,creatinine value,SBP and blood sodium value were all risk factors for in-hospital mortality in elderly patients with heart failure(P<0.05).The results of multiple linear regression showed that blood urea nitrogen,uric acid,SBP and blood sodium were correlated with length of hospital stay in elderly patients with heart failure(P<0.05).When blood sodium decreased by 3 mmol/L at admission,in-hospital mortality increased by 27.00%.When blood sodium<140 mmol/L,in-hospital mortality was negatively correlated with blood sodium(r=-0.477,P<0.05).When blood sodium was>140 mmol/L,it was positively correlated with the length of hospital stay(r=0.609,P<0.05).Conclusion Elderly patients with heart failure have a high probability of hyponatremia,and those with this complication have a high rate of in-hospital mortality,long length of hospital stay,high neurohormonal activity,and poor cardiac function.Effective prevention of hyponatremia in heart failure patients is important to shorten the length of hospital stay and promote regression of patients.