不同血清钠离子水平对高龄心力衰竭患者心功能和预后的影响  

Effect of different serum sodium levels on heart function and prognosis in very elderly patients with heart failure

作　　者：张宇 李新 冷晓 吴存瑾 郭晓坤[1] 黄蛟红 张红梅[1] 王仲言[1] 宋芳[1] 刘乐[1] 于会宁[1] 刘佼磊[1] 刘庆君[1] 王超 王林[1] failure Zhang Yu;Li Xin;Leng Xiao;Wu Cunjin;Guo Xiaokun;Huang Jiaohong;Zhang Hongmei;Wang Zhongyan;Song Fang;Liu Le;Yu Huining;Liu J iaolei;Liu Qingjun;Wang Chao;Wang Lin(Department of Geriatrics,the Second Hospital of Tianjin Medical University and Tianjin Institute of Geriatrics,Tianjin,300211,China（Zhang Y,Li X,Wu CJ,Guo XK,Huang J H,Zhang HM,Wang ZY,Song F,Liu L,Yu HN,Liu JL,Liu QJ,Wang C,Wang L;Division of Geriatric Medicine and Gerontology,School of Medicine,Johns Hopkins University,Baltimore,Maryland,USA（Leng X）Corresponding author ：Wang Lin,Email ：wang.lin@medmail,com.c)

机构地区：[1]医科大学第二医院干部保健医疗部天津市老年病研究所,天津300211 [2]美国约翰霍普金斯大学老年医学中心

出　　处：《中华老年医学杂志》2018年第9期962-965,共4页Chinese Journal of Geriatrics

基　　金：天津市科技计项目（16ZLZXZF00150）

摘　　要：目的探讨不同血清钠离子水平对高龄心力衰竭（心衰）患者心功能和预后影响。方法选取天津市某三级甲等医院老年心衰合并低钠血症患者（≥85岁）152例，根据其血钠水平分为轻度、中度及重度低钠血症组，并选取同期血钠正常老年患者76例为对照组，收集患者一般资料，并测定患者相关血液和临床指标。结果与血钠正常组患者比较，重度低钠血症组患者年龄大、利尿剂应用人数多、血清肌酐水平升高、肌酐清除率水平降低，左心室射血分数（LVEF）降低[（38．1±3．9）％比（45．2±9．7）％]；与其他3组患者比较，重度低钠血症组患者合并冠状动脉粥样硬化性心脏病、糖尿病、慢性肾功能不全、脑卒中人数多[72．4％（21例）比56．6％（43例）、41．4％（12例）比23．7％（18例）、22．6％（8例）比11．8％（9例）、20．6％（6例）比9．2％（7例）]，N末端B型脑钠肽前体（NT-pro-BNP）水平升高[（4823．9±588．1）ng／L比（1124．4±349．1）ng／L（1836．2±369．3）ng／L、（2894．1±687．3）ng/L]，死亡率增加[27．6％（8例）比5．3％（4例）、7．6％（6例）、13．6％（6例）]；重度低钠血症患者住院天数较轻度和中度低钠血症组减少，（11．1±7．1）d比（19．6±5．7）d、（16．1±4．2）d。结论低钠血症是高龄心衰患者常见的电解质紊乱类型，其中重度低钠血症预示患者死亡风险增加。Objective To investigate the effect of different serum sodium levels on heart function and prognosis in very elderly patients with heart failure. Methods Totally 152 elderly patients（aged ≥ 85 years）with hyponatremia were enrolled. Based on the serum sodium level, they were divided into mild（125 mmol/I. Na＋〈135 mmol/L）,moderate（125 mmol/L ≤Na＋〈 135 mmol/L） ,and severe hyponatremia （Na＋ % 115 mmol/L） groups, and 76 patients with normal blood sodium level（Na＋ 〈 135 mmol/L）were selected as control group. The general data,levels of serum creatinine and N-terminal pro-brain natriuretic peptide （NTproBNP）and prognosis were compared among the above groups. Results Compared with the control group, patients with severe hyponatremia were much older, with more diuretics administration, higher level of serum creatinine, lower level of eGFR and left ventricular ejection fractionsE（38.1 ± 3.9）% vs. （45.2±9.7） % ]. There were higher incidences of coronary atherosclerotic heart disease]-72.4 % （n = 21 ） vs. 56.6 % （ n = 43 ） ],diabetes[41.4%（n= 12）vs. 23.7%（n= 18）] ,chronic renal insufficiency[22.6% （n=8）vs. 11.8% （n = 9） 1, stroke[20.60%（ n = 6 ） vs. 9.2 % （ n = 7 ） ] in patients with severe hyponatremia compared with other groups. The severe hyponatremia group showed significantly higher levels of NTproBNP[（4 823.9±588.1）ng/L vs. （1 124.44±349.1）ng/L, （1 836.2±369.3）ng/L,（2 894.1±687.3）ng/L]and higher rates of mortality[27.6%（n=8） vs. 5.3%（n=4）,7.6%（n=6）,13.6%（n=6）]as compared to the control group, mild and moderate hyponatremia groups. Furthermore,length of stay in hospital were markedly longer in patients with severe hyponatremia than those with mild and moderate hyponatremiaF（11,1±7.1）d vs. （19.6±5.7）d,（16.1±4.2）d]. Conclusions Hyponatremia is a common type of electrolyte disorder in very elderly patients with heart failure, and severe hyponatremia may predictand increased risk of death.

关 键 词：低钠血症 心力衰竭 预后 

分 类 号：R541.6[医药卫生—心血管疾病]