西南地区慢性心力衰竭患者合并低钠血症的临床特征
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摘要
目的了解西南地区慢性心力衰竭(chronic heart failure,CHF)患者与低钠血症的关系。方法入选2009年1月至2016年10月西南地区云南省、贵州省、四川省、重庆市12家医院住院的CHF患者,出院诊断为CHF、纽约心脏协会(NYHA)心功能分级处于II～IV级共3 359例进入研究,分析低钠血症与心功能、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDd)、脑钠肽(brain natriuretic peptide,BNP)、血尿酸(serum uric acid,SUA)、血清肌酐(serum creatinine,SCr)的关系。结果心功能Ⅳ级组患者血钠浓度明显低于心功能Ⅱ级与Ⅲ级组,差异有统计学意义(P<0.01)。射血分数降低的心力衰竭(heart failure with reduced ejection fraction,HFrEF)患者低钠血症发病率高于射血分数中间值心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)、射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者,差异有统计学意义(P<0.05)。与非低钠血症组相比,低钠血症组患者SCr、SUA、LVEDd、BNP增高,而LVEF降低,差异有统计学意义(P<0.05)。回归方程分析提示血钠浓度与心功能、BNP、SUA呈负相关。结论低钠血症发生率与心功能有关,心功能越差,低钠血症发生率越高,HFrEF患者低钠血症发病率明显高于HFmrEF、HFpEF患者;血钠浓度与心功能、SCr、SUA、LVEDd、BNP呈负相关。
Objectives To explore the relationship between chronic heart failure(CHF)and hyponatremia in patients in Southwest China. Methos From January 2009 to October 2016,the date of patients with heart failure of New York Heart Association(NYHA)grade from ⅡtoⅣ in 12 hospitals of Yunnan,Guizhou,Sichuan,Chongqing was collected and 3 359 patients entered the study. We analyzed the relationships of hyponatremia and heart function,left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDd),brain natriuretic peptide(BNP),serum uric acid(SUA),serum creatinine(SCr). Results Blood concentration of sodium in NYHA grade IV was significantly lower than that in NYHA grade Ⅱ and III group(P<0.01). Morbidity of hyponatremia in patients with heart failure with reduced ejection fraction(HFrEF)was higher than that in patients with heart failure with mid-range ejection fraction(HFmrEF)and heart failure with preserved ejection fraction(HFpEF)(P<0.05). Compared with non hyponatremia group,SCr,SUA,LVEDd,BNP in hyponatremia group significantly increased,however,LVEF decreased(P<0.05). Multivariate correlation analysis showed that serum concentration of sodium negatively correlated with cardiac function,BNP,SUA. Conclusions Incidence of hyponatremia related to the classification of cardiac function. The worse the cardiac function is,the higher the incidence of hyponatremia is. Incidence of hyponatremia in patients with HFrEF was higher than that in patients with HFmrEF and HFpEF. Serum concentration of sodium negatively correlates with cardiac function.
Objectives To explore the relationship between chronic heart failure(CHF)and hyponatremia in patients in Southwest China. Methos From January 2009 to October 2016,the date of patients with heart failure of New York Heart Association(NYHA)grade from ⅡtoⅣ in 12 hospitals of Yunnan,Guizhou,Sichuan,Chongqing was collected and 3 359 patients entered the study. We analyzed the relationships of hyponatremia and heart function,left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDd),brain natriuretic peptide(BNP),serum uric acid(SUA),serum creatinine(SCr). Results Blood concentration of sodium in NYHA grade IV was significantly lower than that in NYHA grade Ⅱ and III group(P<0.01). Morbidity of hyponatremia in patients with heart failure with reduced ejection fraction(HFrEF)was higher than that in patients with heart failure with mid-range ejection fraction(HFmrEF)and heart failure with preserved ejection fraction(HFpEF)(P<0.05). Compared with non hyponatremia group,SCr,SUA,LVEDd,BNP in hyponatremia group significantly increased,however,LVEF decreased(P<0.05). Multivariate correlation analysis showed that serum concentration of sodium negatively correlated with cardiac function,BNP,SUA. Conclusions Incidence of hyponatremia related to the classification of cardiac function. The worse the cardiac function is,the higher the incidence of hyponatremia is. Incidence of hyponatremia in patients with HFrEF was higher than that in patients with HFmrEF and HFpEF. Serum concentration of sodium negatively correlates with cardiac function.
引文
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[6]中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[7]中华医学会心血管病学分会心力衰竭学组.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志,2018,46(10):760-789.
[8]葛俊波,徐永健.内科学[M]. 8版.北京人民卫生出版社,2013:166.
[9]蔡凤姣,贾杏阳.严重心衰并低钠血症的临床分析[J].中国现代医学杂志,2003,13(22):144-145.
[10] CORONA G,GIULIANI C,PARENTI G,et al. Moderate hyponatremia is associated with increased risk of mortality:evidence from a meta analysis[J]. Plos One,2013,8(12):451-455.
[11] COSTACHE I I,ALEXANDRESCU D M,CIMPOE?U D,et al. Hyponatremia--risk factor in patients with chronic heart failure--clinical,evolutive and therapeutic implications[J].Rev Med Chir Soc Med Nat Iasi,2014,118(2):315-319.
[12] ISHIKAWA S E. Hyponatremia associated with heart failure:pathological role of vasopressin-dependent impaired water excretion[J]. J Clin Med,2015,4(5):933-947.
[13] BAVISHI C,ATHER S,BAMBHROLIYA A,et al. Prognostic significance of hyponatremia among ambulatory patients with heart failure and preserved and reduced ejection fractions[J].Am J Cardiol,2014,113(11):1834-1838.
[14] PARK J J,CHO YJ,OH I Y,et al. Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction:An analysis of the Korean Acute Heart Failure registry[J]. Int J Cardiol,2017,248:239-245.
[15]王传合,刘双双,杨丽娜,等.低钠血症与慢性心力衰竭的相关性及预后分析[J].天津医药,2015,43(10):1159-1162.
[16] PENG D F,TANG S Y,HU Y J,et al. Pathophysiological model of chronic heart failure complicated with renal failure caused by three-quarter nephrectomy and subcutaneous injection of isoprenaline[J]. Exp Ther Med,2013,5(3):835-839.
[17]黄燕,邹长虹,张荣成,等.住院心力衰竭患者入院时低钠血症的发生率及其对预后的影响[J].中华心血管病杂志,2015,43(10):868-873.
[2]黄姣红,王林,安芳,等.低钠血症在慢性心力衰竭患者中30年发生率的变化及原因探讨[J].天津医药,2009,37(9):727-729.
[3] PITT B,POOL-WILSON P A,SEGAL R,et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure:randomized trial-the Losartan Heart Failure Survival Study ELITEII[J]. Lancet, 2000, 355(9215):1582-1587.
[4] BURKE M A,COTTS W G. Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions[J].Heart Fail Rev,2007,12(1):23-36.
[5] LU D Y,CHENG H M,LUN C Y,et al. Hyponatremia and Worsening sodium levels are associated with long-term outcome in patients hospitalized for acute heart failure[J].J Am Heart Assoc,2016,5(3):78-83.
[6]中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[7]中华医学会心血管病学分会心力衰竭学组.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志,2018,46(10):760-789.
[8]葛俊波,徐永健.内科学[M]. 8版.北京人民卫生出版社,2013:166.
[9]蔡凤姣,贾杏阳.严重心衰并低钠血症的临床分析[J].中国现代医学杂志,2003,13(22):144-145.
[10] CORONA G,GIULIANI C,PARENTI G,et al. Moderate hyponatremia is associated with increased risk of mortality:evidence from a meta analysis[J]. Plos One,2013,8(12):451-455.
[11] COSTACHE I I,ALEXANDRESCU D M,CIMPOE?U D,et al. Hyponatremia--risk factor in patients with chronic heart failure--clinical,evolutive and therapeutic implications[J].Rev Med Chir Soc Med Nat Iasi,2014,118(2):315-319.
[12] ISHIKAWA S E. Hyponatremia associated with heart failure:pathological role of vasopressin-dependent impaired water excretion[J]. J Clin Med,2015,4(5):933-947.
[13] BAVISHI C,ATHER S,BAMBHROLIYA A,et al. Prognostic significance of hyponatremia among ambulatory patients with heart failure and preserved and reduced ejection fractions[J].Am J Cardiol,2014,113(11):1834-1838.
[14] PARK J J,CHO YJ,OH I Y,et al. Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction:An analysis of the Korean Acute Heart Failure registry[J]. Int J Cardiol,2017,248:239-245.
[15]王传合,刘双双,杨丽娜,等.低钠血症与慢性心力衰竭的相关性及预后分析[J].天津医药,2015,43(10):1159-1162.
[16] PENG D F,TANG S Y,HU Y J,et al. Pathophysiological model of chronic heart failure complicated with renal failure caused by three-quarter nephrectomy and subcutaneous injection of isoprenaline[J]. Exp Ther Med,2013,5(3):835-839.
[17]黄燕,邹长虹,张荣成,等.住院心力衰竭患者入院时低钠血症的发生率及其对预后的影响[J].中华心血管病杂志,2015,43(10):868-873.