住院心力衰竭患者血清钠水平与病情的相关性分析

目的探讨住院心力衰竭患者血清钠水平与病情的相关性。方法收集广州市某三甲医院心血管内科2014年1月至2017年1月住院资料完整的症状性心力衰竭患者739例,均为纽约心脏病学会心功能分级(NYHA)Ⅱ～Ⅳ级者,回顾性分析其临床资料。按患者入院时血钠浓度将其分为两组,低钠组(血钠<135 mmol/L)89例,非低钠组(血钠≥135 mmol/L)650例。分析739例心力衰竭患者血钠浓度、心功能指标及预后。结果 739例心力衰竭住院患者中低钠血症比例为12.0%(89/739),其中轻度低钠血症占49.4%;中度低钠血症占33.7%;重度低钠血症占16.9%。与非低钠血症心力衰竭患者比较,低钠血症患者入院时血压水平较低、左心室射血分数低、NT-proBNP水平较高(P均<0.01);低钠组心功能Ⅳ级占比高于非低钠组(Z=21.805,P<0.01),住院时间长于非低钠组(P<0.01)。低钠组住院累积死亡率为10.1%,非低钠组为1.5%,低钠组住院累积死亡率高于非低钠组(P<0.01)。结论该院住院心力衰竭患者中,伴有低钠血症者入院病情较血钠正常者严重。心力衰竭合并低钠血症者心功能差、住院时间长、住院病死率高。

Relationship between admission serum sodium concentration and clinical outcomes in patients with heart failure

Objective To investigate the relationship between serum sodium concentration and clinical outcomes in admission patients with heart failure. Methods A total of 739 patients with symptomatic heart failure with complete inpatient data from January 2014 to January 2017 in a triple-a hospital in Guangzhou were collected, all of whom were Ⅱ~Ⅳ in the Heart Function classification(NYHA) of the New York Heart Society, its clinical data were retrospectively analyzed. According to the concentration of blood sodium at the time of admission, the patients were divided into two groups, the low sodium group(blood sodium level <135 mmol/L) was 89 cases and the non-low sodium group was 650 cases(blood sodium level ≥135 mmol/L). The blood sodium concentration, cardiac function index and prognosis of 739 patients with heart failure were analyzed. Results The proportion of hyponatremia in 739 hospitalized patients with heart failure was 12%(89/739), amorg which,the proportion of mild hyponatremia was 49.4%, the proportion of moderate hyponatremia was 33.7%, and the proportion of severe hyponatremia was 16.9%. Compared with the non-hyponatremia group, the levels of admission blood pressure and left ventricular ejection fraction were lower in the hyponatremia group(P<0.01). The levels of N-terminal B-type brain natriuretic peptide(pro-BNP) was higher in the hyponatremia group(P<0.01). The proportion of patients with low sodium cardiac function Ⅳ grade was higher than that in non-low sodium group(Z=21.805,P<0.01), and the length of hospital stay was longer than that of non-low sodium group(P<0.01). The cumulative mortality rate in low sodium group was 10.1%, that of the non-sodium group was 1.5%, and the cumulative mortality rate of inpatient in low sodium group was higher than that in non-low sodium group(P<0.01).Conclusions In patients with heart failure hospitalized in the hospital, those with hyponatremia admitted to hospital with severe blood sodium than normal. Patients with heart failure complicated with hyponatremia have impaired cardiac function, longer length of hospital stay and higher in-hospital mortality.