血清Na^(+)水平对慢性心力衰竭患者预后的预测价值  

Prognostic value of serum Na^(+) level in patients with chronic heart failure

作　　者：努尔比牙·吾买尔 郭玉君[1] 姑丽努尔·麦麦提吐尔逊 艾力曼·马合木提[1] 惠睿 丁慧敏 Nuerbiya Wumaier;GUO Yujun;Gulinuer Maimaitituerxun;Ailiman Mahemuti;HUI Rui;DING Huimin(Department of Cardiac Failure,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;the First People′s Hospital of Kashgar,Kashgar Xinjiang 844000,China)

机构地区：[1]新疆医科大学第一附属医院心力衰竭科,乌鲁木齐830054 [2]喀什地区第一人民医院,新疆喀什844000

出　　处：《新疆医科大学学报》2023年第6期751-758,共8页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金重点项目(2021D01D17)。

摘　　要：目的 研究血清Na^(+)水平对慢性心力衰竭(Chronic heart failure, CHF)患者预后的预测价值。方法 以2021年1月-12月新疆医科大学第一附属医院心力衰竭科收治的104例CHF伴有低钠血症的患者为低钠血症组,随机抽取研究期间血清Na^(+)水平正常的127例CHF患者为正常血钠组。比较两组患者的临床指标及预后情况,评估血清Na^(+)水平对CHF患者预后的影响。结果 Kaplan-Meier生存分析结果表明伴有低钠血症的CHF患者预后较血清Na^(+)水平正常CHF患者差(Plog rank=0.014),多因素COX回归分析提示血清Na^(+)水平和N端前脑钠肽(NT-proBNP)是CHF全因死亡的独立预测因子(P<0.05),血清Na^(+)水平是CHF患者发生死亡的独立保护因素。受试者工作特征曲线(ROC)显示:血清Na^(+)水平的敏感度为0.564,特异度为0.693,约登指数为0.257,AUC为0.641,(95%CI:0.554-0.728,P=0.002),临界值为134.55 mmol/L。NT-proBNP的敏感度为0.964,特异度为0.318,约登指数为0.282,AUC为0.672,(95%CI:0.593-0.750,P<0.001),临界值为938 pg/mL。两者联合评估CHF预后的AUC为0.700。结论 血清Na^(+)水平对CHF预后具有预测价值,是CHF预后的保护性因素。血清Na^(+)水平和NT-proBNP联合评估可提高对心衰预后的预测价值。Objective To study the predictive value of serum Na^(+) level in admission for the prognosis of chronic heart failure(CHF).Methods 104 patients with hyponatremia in CHF hospitalized in the Heart Failure Department of the hospital from January to December 2021 as the hyponatremic group,and 127 patients with CHF with normal serum Na^(+) levels during the study period were randomly selected as the normonatremic group,to compare the clinical indicators and prognosis of the two groups,and to assess the effect of Na^(+) on the prognosis CHF.Results[WTBX]Kaplan-Meier curve indicated that CHF patients with hyponatremia were responsible for a worse prognosis than CHF patients with normal serum Na^(+) (P log rank=0.014).Multifactorial COX regression analysis suggested that both of serum Na^(+) and NT-proBNP were independent predictors of all-cause mortality in CHF(P<0.05),and the serum Na^(+) was an independent protective factor against the morality in patients with CHF.The receiver operating characteristic curve(ROC)displayed that the sensitivity of serum Na^(+) level was 0.564,the specificity was 0.693,the Youden index was 0.257,the AUC was 0.641(95%CI:0.554-0.728,P=0.002),and the cut-off value of serum Na^(+) was 134.55 mmol/L.The sensitivity of NT proBNP was 0.964,specificity was 0.318,Youden index was 0.282,the AUC was 0.672(95%CI:0.593-0.750,P<0.001),and the cut-off value was 938 pg/mL.The AUC of the combined assessment of CHF prognosis was 0.700.Conclusion Serum Na^(+) has predictive value for the prognosis of CHF and plays a protective role for the prognosis of CHF.The combined assessment of serum Na^(+) level and NT-proBNP can improve the prognostic value of heart failure.

关 键 词：慢性心力衰竭 血清Na^(+)水平 预后 预测价值 

分 类 号：R541[医药卫生—心血管疾病]