充血性心力衰竭患者血钠水平与其神经内分泌激素水平、运动耐量及再住院率的关系  

Relationship of level of serum sodium with plasma concentration of neuroendocrine hormone, exercise tolerance and the rate of rehospitalization in patients with congestive heart failure

作　　者：葛海龙[1] 富路[1] 李佳[1] 陈光远[1] 范春艳[2] 李为民[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院心内科,黑龙江哈尔滨150001 [2]哈尔滨医科大学第一临床医学院超声科

出　　处：《中国康复医学杂志》2006年第5期428-430,共3页Chinese Journal of Rehabilitation Medicine

基　　金：黑龙江省自然科学基金重点项目(ZJY0507)

摘　　要：目的:探讨充血性心力衰竭患者低钠水平对其相关神经内分泌激素水平、运动耐量的影响,并通过观察比较再入院率,明确低钠水平对心衰患者康复和预后的作用。方法:选择2004年2月—2005年4月我院心内科确诊为充血性心力衰竭、NYHAⅡ—Ⅳ级的住院患者,共106例,包括56例充血性心力衰竭伴低钠血症患者和50例正常血钠的慢性心力衰竭患者,用放射免疫法、心脏超声同时测定106例慢性心力衰竭患者血浆NE、ALD、AngⅡ水平和LVEF。结果:低钠水平的充血性心力衰竭患者血浆NE、ALD、AngⅡ水平均较正常血钠组显著升高,NE(0.92±0.24ng/mlvs0.48±0.15ng/ml,t=3.865,P<0.01),ALD(264.05±42.85ng/Lvs154.56±39.34ng/L,t=2.521,P<0.05),AngⅡ(251.35±70.06ng/Lvs106.08±30.15ng/L,t=3.275,P<0.01)。低钠水平与血浆NE、ALD、AngⅡ水平呈显著负相关(r=-0.33,P<0.05;r=-0.69,P<0.01)。低钠水平组的心衰患者6min步行距离明显短于正常血钠组298.45±26.35mvs390.25±29.65m,P<0.05。6个月内因心衰的再入院率明显高于正常血钠组(χ2=117.96,P<0.05)。结论:低钠水平可能促进充血性心力衰竭患者神经内分泌激素激活水平,明显减低其运动耐量,增加再入院率,影响心衰患者的康复和预后。Objective：To observe the effect of level of serum sodium on plasma concentration of neuroendocrine hormone,exercise tolerance, the rate of rehospitalization in patients with congestive heart failure （CHF） and to analyze the effect of hyponatremia on rehabilitation and prognosis of patients with CHF. Method：106 CHF patients of grade Ⅱ-Ⅳ diagnosed according to the standard of New York Heart Association （NYHA） were selected. All the patients were divided into Hyponatremia group and norml natremia group. The plasma levels of aldosterone,norepinephrine,renin angiotensin Ⅱ were measured with radioimmunology. The LVEF was measured by ultrasound in 56 CHF patients with hyponatremia and 50 CHF patients without hyponatremia. Result： The plasma levels of NE, ALD,AngⅡ in CHF patients with hyponatremia were notably higher than those in patients without hyponatremia.As follows：NE（0.92±0.24ng/ml vs 0.48±0.15ng/ml,t=3.865,P〈0.01）,ALD（264.05±42.85ng/L vs 154.56±39.34ng/L,t=2.521, P〈0.05）,AngⅡ （251.35±70.06 ng/L vs 106.08±30.15ng/L,t=3.275,P〈0.01）,6-minute walking distance in hyponatremia group（298.45±26.35m） was remarkably shorter than that in normal natrium group [390.25±29.65m,t=2.536,P〈0.05]. There was correlation among in the simple regression analyses,hyponatremia was negative correlated significantly with NE,ALD,AngⅡ （r=-0.33,P〈0.05; r=-0.31,P〈0.05; r=-0.69,P〈0.01）. The rate of rehospitalization within 6 months in hyponatremia group（18%,32.14.%） was remarkably shorter than that in normal natrium group（6%,8%）（χ^2= 117.96,127.65,P〈0.05）.Conclusion：Hyponatremia may accelerate the excretion of plasma concentration of neuroendocrine hormone in patients with congestive heart failure. The rate of rehospitalization can be improved by hyponatremia.

关 键 词：心力衰竭/充血性 低钠 神经内分泌学 激素类 康复 

分 类 号：R541.61[医药卫生—心血管疾病]