低钠血症对急性ST段抬高心肌梗死预后判断的意义

目的探讨低钠血症对急性ST段抬高心梗（ASTEMI）预后判断的意义。方法ASTEMI患者234例，根据入院后即刻、24h、48h血清钠离子浓度（Na^＋）低值分组：N组Na^＋〉136．0mmol／L，M组Na^＋120．0-136．0mmol／L，L组Na^＋〈120．0mmol／L。比较各组心肌酶、梗死面积及住院病死率。结果①L组住院病死率（30．0％，6／20）高于N组（7．8％，8／103）与M组（8．1％，9／111），差异有统计学意义（P〈0．05），M组与N组间差异无统计学意义（P〉0．05）。②L组心肌酶（CK、CK—MB）[（3376±314）U／L、（201±19）U／L]、梗死面积[（20．0±2．4）％]大于N组[（2042±172）U／L、（114±13）U／L、（15．0±1．9）％]和M组[（2138±209）U／L、（122±14）U／L、17．0％±2.3％]，差异有统计学意义（P〈0．05）；M组与N组间差异无统计学意义（P〉0．05）。③住院期间死亡23例，死亡组Na^＋[（122．00±7．25）mmol／L]低于存活组[（133．00±5．25）mmol／L]，差异有统计学意义（P〈0．01）。④对ASTEMI后30d住院期间死亡危险因素进行多因素Logistic回归分析，Na^＋降低与ASTEMI后30d住院期间病死率相关。30d住院期间病死率随着Na^＋降低而升高。结论在ASTEMI中出现的低钠血症与患者的心衰发生率、心源性休克发生率及住院病死率密切相关。低钠血症可能是ASTEMI预后不良的标志之一。

The prognostic value of hyponatremia in patients with acute ST-segment elevation myocardial infarction

Objective To evaluate the prognostic significance of hyponatremia in patients with acute STEMI. Methods 234 patients with acute STEMI were designed into three groups according to serum sodium concentration within twenty four to forty eight hours： Group N, Na^＋〉136.0 mmol/L. Group M, Na^＋ 120.0-136.0 mmol/L. Group L, Na^＋〈120.0 mmol/L. The data of myocardial enzymes, myocardial infarction size （S） and inhospital mortality （IM） were analyzed retrospectively. Results （1）IM： group L （30.0%, 6/20） was higher than group N （7.8%,8/103） and group M （8.1%,9/111）, the difference was significant （P〈0.05）. （2）Myocardial enzymes （CK,CK-MB）,S： group L [（3376±314）U/L, （201±19）U/L, （20.0±2.4）%] was higher than group N [ （2042±172）U/L, （ 114±13）U/L, （ 15.0±1.9）%] and group M [ （2138±209）U/L, （ 122±14）U/L, （ 17.0±2.3）%], the difference was significant （P〈0.05）. There was no significant difference between group N and group M （P〉 0.05 ）. （3）23 cases of all died in duration of hospital stay. Serum sodium concentrations of the died group （ 122.00±7.25mmol/L） was lower than the recovered group [（133.00±5.25）mmol/L], the difference was significant （P〈 0.01 ）. （4）In a multivariate logistic regression analysis, hyponatremia was associated with 30-day mortality in patients with acute STEMI. In analysis of the association between the degree of hyponatremia and outcome, the risk of 30-day mortality increased with the severity of hyponatremia. Conclusion Hyponatremia may be one of the important markers that predict a worse prognosis in patients with acute STEMI.