血清钠和血尿素氮对急性失代偿性心力衰竭病人预后的影响  

The Relationship between Serum Sodium and Blood Urea Nitrogen and Prognosis in Patients with Acute Decompensated Heart Failure

作　　者：张娜[1] 魏彤[1] 刘长凯[1] ZHANG Na;WEI Tong;LIU Changkai(Zhengzhou First People′s Hospital,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州市第一人民医院,郑州450000

出　　处：《中西医结合心脑血管病杂志》2020年第19期3245-3249,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：河南省医学科技攻关计划项目(No.201604139)。

摘　　要：目的探讨血清钠和血尿素氮与急性失代偿性心力衰竭病人预后结局的关系。方法选取本院急性失代偿性心力衰竭病人140例为病例组,入选门诊健康体检者116名作为对照组。测定两组观察者超敏C-反应蛋白(hs-CRP)、血清钠、血尿素氮(BUN)、肌酸激酶(CK)、收缩期左房前后径(LAD)、右房上下径(RAD)、左室射血分数(LVEF)、心肌肌钙蛋白I(cTnI)水平等。结果病例组血清钠水平低于对照组,BUN水平高于对照组,差异有统计学意义(P<0.05);病例组CK、cTnI、hs-CRP表达高于对照组,差异有统计学意义(P<0.05);病例组LAD、RAD水平高于对照组,LVEF水平低于对照组,差异有统计学意义(P<0.05);随着心功能分级逐渐增加,血清钠水平逐渐降低、BUN水平逐渐增加,差异有统计学意义(P<0.05);血清钠与CK、cTnI、hs-CRP、LAD、RAD、心功能分级呈负相关,与LVEF呈正相关;BUN与CK、cTnI、hs-CRP、LAD、RAD、心功能分级呈正相关,与LVEF呈负相关(P<0.05);高水平BUN及低水平LVEF、血清钠均为急性失代偿性心力衰竭发生不良事件的危险因素(P<0.05);BUN、血清钠两者的AUC相近,皆小于LVEF;BUN、血清钠诊断急性失代偿性心力衰竭的灵敏度、特异度相近(P>0.05),皆小于LVEF(P<0.05)。结论低血清钠和高BUN水平是急性失代偿性心力衰竭病人随后出现不良预后的危险因素;BUN、血清钠诊断急性失代偿性心力衰竭具有较高的灵敏度、特异度。Objective To observe the relationship between serum sodium and blood urea nitrogen and prognosis in patients with acute decompensated heart failure.Methods One hundred and forty patients with acute decompensated heart failure were selected as the patient group and 116 cases of health examinees were selected as the control group.The levels of hypersensitive C-reactive protein(hs-CRP),serum sodium Na+,blood urea nitrogen(BUN),creatine kinase(CK),systolic left anteroposterior diameter(LAD),right atrial up-down diameter(RAD),left ventricular ejection fractions(LVEF)and cardiac troponin I(cTnI)were compared between two groups.Results The levels of Na+and LVEF in the patient group were lower than those in the control group.The levels of BUN,CK,cTnI,hs-CRP,LAD,and in the patient group was higher than those in the control group(P<0.05).With the increase of cardiac function grading,the level of Na+was decreased and BUN was increased gradually(P<0.05).Na+was negatively correlated with CK,cTnI,hs-CRP,LAD,RAD,and cardiac function classification,while Na+was positively correlated with LVEF.BUN was positively correlated with CK,cTnI,hs-CRP,LAD,RAD and cardiac function grading,while BUN was negatively correlated with LVEF(P<0.05).High BUN,low LVEF,and low Na+were risk factors for adverse events in patients with acute decompensated heart failure(P<0.05).The AUC of BUN and Na+was similar,which was lower than that of LVEF,indicating that the diagnosis sensitivity and specificity of BUN and Na+were lower than those of LVEF(P<0.05).Conclusion Low Na+and high BUN were risk factors for poor prognosis in patients with acute decompensated heart failure,while the sensitivity and specificity of two indicators were relatively high.

关 键 词：急性失代偿性心力衰竭 血清钠 血尿素氮 不良事件 危险因素 预后 

分 类 号：R541.6[医药卫生—心血管疾病] R256.2[医药卫生—内科学]