西南地区慢性心力衰竭患者合并低钠血症的临床特征  

Clinical features of patients with chronic heart failure and hyponatremia in Southwest China

作　　者：赵秋燕 杨瑛 陈章荣 吴新华 张健[2] 董申 杨伟 刘权仪 刘宏 ZHAO Qiu-yan;YANG Ying;CHEN Zhang-rong;WU Xin-hua;ZHANG Jian;DONG Shen;YANG Wei;LIU Quan-yi;LIU Hong(Department of Cardiology,The First Affiliated Hospital of Dali University,Dali,Yunnan 671000,China;Fuwai Hospital of Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]大理大学第一附属医院心血管内科,云南大理671000 [2]中国医学科学院阜外心血管病医院心力衰竭中心,北京100037

出　　处：《岭南心血管病杂志》2019年第3期322-326,共5页South China Journal of Cardiovascular Diseases

基　　金：“十二五”国家科技支撑计划重大项目(项目编号:2011BA111B02);国家自然科学基金(项目编号:81560073)

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.

关 键 词：心力衰竭 低钠血症 血钠浓度 

分 类 号：R541.6[医药卫生—心血管疾病]