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  • 吕洋波,潘 新,胡小露,等.低钠血症对射血分数保留的心力衰竭住院患者预后的预测价值[J].同济大学学报(医学版),2019,40(5):570-574,579.    [点击复制]
  • Lü Yang-bo,PAN Xin,HU Xiao-lu,et al.Prognostic Value of Hyponatremia in Heart failure with preserved ejection fraction[J].同济大学学报(医学版),2019,40(5):570-574,579.   [点击复制]
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低钠血症对射血分数保留的心力衰竭住院患者预后的预测价值
吕洋波,潘新,胡小露,许冲,徐亚伟,徐大春
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(同济大学附属第十人民医院心血管内科,上海 200072;同济大学附属第十人民医院老年病科,上海 200072;上海市宝山区罗店医院心内科,上海 201908)
摘要:
目的 通过前瞻性队列研究探索射血分数保留的心力衰竭(heart failure with preserved ejection fraction, HFpEF)住院患者低钠血症的临床特征及其预后。方法 通过注册名为“DRAGON-HF(NCT03727828)”的临床研究,连续收集2017年7月—2018年12月在同济大学附属第十人医院心内科住院的心力衰竭(心衰)患者一般情况、疾病史、实验室检查、心脏彩超、临床用药等临床资料。低钠血症定义为入院时血清Na+<135mmol/L。通过Logistic回归模型及Cox比例风险回归模型等方法评估低钠血症对HFpEF患者预后的预测价值。结果 在672例心衰患者中,HFpEF共318例(47%),按血清钠浓度进一步分为低钠组(Na+<135mmol/L,n=32,10%)及非低钠组(Na+≥135mmol/L,n=286,90%)。血清钠浓度与纽约心脏病学会心功能分级、NT-proBNP水平、收缩压水平、总胆红素水平等显著相关(P<0.05)。316例存活出院后,通过电话随访及查阅病历系统等方式记录再住院率及全因死亡率,平均随访(23±3.65)个月后,全因死亡率及再住院率分别为10.1%及27.0%,而低钠血症组上述数值分别为(21.9% vs 8.7%,P<0.05)和(75% vs 21.7%,P<0.05),均明显高于非低钠组。在校正其他显著差异变量后,利用多变量Cox回归模型分析,低钠血症仍是HFpEF患者全因死亡的独立预测因素(HR=2.545,95%CI: 1.096~5.914,P=0.03)。结论 低钠血症是心衰患者常见的并发症之一,且与HFpEF患者全因死亡率显著相关。
关键词:  低钠血症  预后  死亡率  射血分数保留的心力衰竭
DOI:10.16118/j.1008-0392.2019.05.007
投稿时间:2019-08-10
基金项目:国家自然科学基金(81770391)
Prognostic Value of Hyponatremia in Heart failure with preserved ejection fraction
Lü Yang-bo,PAN Xin,HU Xiao-lu,XU Chong,XU Ya-wei,XU Da-chun
(Dept of Cardiology, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China;Dept of Geratology, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China;Dept of Cardiology, Luodian Hospital of Baoshan District, Shanghai 201908, China)
Abstract:
Objective To investigate the prognostic value of hyponatremia in patients with Heart failure with preserved ejection fraction(HFpEF). Methods The clinical data of 672 patients with symptomatic heart failure, who were admitted in Cardiology Department of Shanghai Tenth People’s Hospital from July 2017 to December 2018, were collected from clinical trial DRAGON-HF(NCT03727828). The basic findings,laboratory results,ecocardiographic parameter were also collected. Results Among 672 patients there were 318 cases of HFpEF, among whom 32 cases with hyponatremia(circulating sodium<135mmol/L)(hyponatremia group) and 286 cases with normal blood sodium level(non-hyponatremia group) at admission. There were significant differences in NYHA level, NT-proBNP level, systolic blood pressure(SBP), and total bilirubin level(P<0.05) between two groups. Three hundred and thirty-six survival patients were discharged, after 23±3.65 months of follow-up the overall all-cause mortality rate and rehospitalization rate of discharged patients were 10.1% and 27.0%, respectively. The all-cause mortality rate in hyponatremia group was significantly lower(8.7% vs 21.9%,P<0.05) and the rehospitalization rate was significantly higher(75% vs 21.7%,P<0.05) than those in the non-hyponatremia group. The adjusted multivariate Cox regression model showed that hyponatremia at admission was an independent predictor for all-cause death(HR=2.545,95%CI: 1.096~5.914,P=0.03). Conclusion Hyponatremia is a common complication of HF patients and is an independent predictor for all-cause mortality in patients with HFpEF.
Key words:  hyponatremia  prognosis  mortality  heart failure with preserved ejection fraction

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