慢性心力衰竭合并低氯血症的临床特点及预后研究  

Clinical characteristics and prognosis of chronic heart failure with hypochloremia

作　　者：卜宪环 董彬[2] Bu Xianhuan;Dong Bin(Changzhi Medical College,Changzhi,Shanxi,046000,China;Department of Cardiovascular Medicine,Heping Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi,046000,China)

机构地区：[1]长治医学院,山西长治046000 [2]长治医学院附属和平医院心血管内科,山西长治046000

出　　处：《当代医学》2020年第31期13-16,共4页Contemporary Medicine

基　　金：《托伐普坦对心衰合并低氯血症患者的临床研究》(HPYJ201940)。

摘　　要：目的探究低氯血症对慢性心力衰竭(CHF)患者预后的重要性。方法回顾性分析289例CHF患者的临床资料,根据患者入院时化验的血钠和血氯浓度分为单纯低钠组(钠<135 mmol/L且氯>96 mmol/L)、低钠低氯组(钠<135 mmol/L且氯≤96 mmol/L)与正常组(正常血钠血氯)。分别收集3组患者的既往病史、院外用药情况、临床检查指标等数据,并随访患者出院后6个月内心血管事件发生及再入院情况。结果共有144例CHF患者出现低钠血症,其中64例(44%)患者同时合并低氯血症。单纯低钠组患者的血肌酐、eGFR、BNP、肌钙蛋白及LVEF与正常组比较差异无统计学意义。低钠低氯组与正常组及单纯低钠组比较,血肌酐、肌钙蛋白、BNP水平均升高,LVEF、eGFR及血钠浓度均降低,心血管事件发生率(36%vs. 13%vs. 8%)及再入院率增高(23%vs. 6%vs. 5%),差异有统计学意义(P<0.05)。结论氯离子相对钠离子,与CHF患者预后有更大的相关性,低氯血症可增加心衰患者不良预后。Objective To investigate the significance of hypochloremia in the prognosis of patients with chronic heart failure(CHF).Methods Retrospective analysis was conducted on 289 hospitalized patients with CHF.According to the serum sodium and blood chlorine concentrations measured at the time of admission,patients were divided into the simple low sodium group(sodium<135 mmol/L and chlorine>96 mmol/L),the low sodium and low chlorine group(sodium<135 mmol/L and chlorine≤96 mmol/L),and the normal group(normal blood natriuretic chloride).The previous medical history,out-of-hospital medication,clinical examination indicators and other data of the three groups were collected,and the incidence of cardiovascular events and readmission of the patients within 6 months after discharge were followed up.Results A total of 144 CHF patients developed hyponatremia,of which 64(44%)were associated with hyponatremia.There was no significant difference in serum creatinine,eGFR,BNP,troponin and LVEF between the low-sodium group and the normal group.Serum creatinine,troponin,BNP,LVEF,eGFR and sodium concentration were decreased,the incidence of cardiovascular events(36%vs.13%vs.8%)and readjustments(23%vs.6%vs.5%)in the low-sodium and low-chlorine groups compared with the normal group and the low-sodium group alone,the difference was statistically significant(P<0.05).Conclusion Chloride ions are more correlated with the prognosis of CHF patients than sodium ions,and hypochloremia can increase the poor prognosis of patients with heart failure.

关 键 词：慢性心力衰竭 低氯血症 预后 

分 类 号：R541.6[医药卫生—心血管疾病]