持续性低氯血症评估射血分数保留型心力衰竭远期预后的价值  

The predictive value of persistent hypochloremia in the long-term prognosis of heart failure with preserved ejection fraction

作　　者：林飞宁[1] 黄丽华[2] 林超[1] 熊尚全[1] LIN Feining;HUANG Lihua;LIN Chao;XIONG Shangquan(Department of Cardiology,Affiliated People's Hospital,Fujian University of Traditional Chinese Medicine,Fuzhou,350004,China;Department of Laboratory,Affiliated People's Hospital,Fujian University of Traditional Chinese Medicine,Fuzhou,350004,China)

机构地区：[1]福建中医药大学附属人民医院心血管科,福州350004 [2]福建中医药大学附属人民医院检验科

出　　处：《临床心血管病杂志》2024年第5期372-376,共5页Journal of Clinical Cardiology

基　　金：福建省自然科学基金联合资金项目(No:2023J01830)。

摘　　要：目的:评价持续性低氯血症对射血分数保留型心力衰竭(HFpEF)患者出院1年全因死亡的预测价值。方法:回顾性收集2021年1月—2022年12月于福建省人民医院心血管科出院的HFpEF患者329例,根据患者住院期间平均血氯四分位水平,将患者分为Q1组(平均血氯<98.0mmol/L)、Q2组(98.0mmol/L≤平均血氯<101.5mmol/L)、Q3组(101.5mmol/L≤平均血氯<104.5mmol/L)和Q4组(平均血氯≥104.5mmol/L)。出院后定期门诊或电话随访。采用Kaplan-Meier生存曲线比较各组患者出院1年生存率的差异,Cox回归分析HFpEF患者出院1年全因死亡的危险因素,ROC曲线评估住院期间平均血氯和入院时血氯对HFpEF患者1年死亡的预测价值。结果:Q1、Q2、Q3、Q4组患者出院后1年全因死亡率分别为11.0%、4.9%、3.7%、1.2%(P=0.034)。Kaplan-Meier生存曲线分析显示,持续性低氯血症患者出院1年生存率低于一过性低氯血症患者(P=0.025)。多因素Cox回归分析显示,平均血氯是HFpEF患者随访1年全因死亡的独立危险因素(HR=1.29,95%CI:1.10~1.42,P=0.033)。住院期间平均血氯、入院时血氯预测患者1年全因死亡的ROC曲线下面积分别为0.819、0.698。结论:住院期间平均血氯水平与HFpEF患者1年不良预后相关,其预测HFpEF患者1年预后的价值大于单次的入院时血氯。Objective:To evaluate the predictive value of persistent hypochloremia for l-year all-cause mortality in patients with heart failure with preserved ejection fraction(HFpEF).Methods:A total of 329 patients with HFpEF who were discharged from the Department of Cardiology,Fujian Provincial People's Hospital from January 2021 to December 2022 were retrospectively collected.The patients were divided into four groups according to the mean blood chloride quartile level during hospitalization:Ql group(mean blood chloride<98.0 mmol/L),Q2 group(98.0 mmol/L≤mean blood chloride<101.5 mmol/L),Q3 group(101.5 mmol/L≤mean blood chloride<104.5 mmol/L)and Q4 group(mean blood chloride≥104.5 mmol/L).Regular outpatient or telephone followup were conducted after discharge.Kaplan-Meier survival curve was used to compare the l-year survival rate among the four groups.Cox regression analysis was used to analyze the risk factors of 1-year all-cause death.ROC curve was used to evaluate the predictive value of average blood chlorine during hospitalization and the blood chlorine on admission for 1-year death.Results:The 1-year all-cause mortality rates in Q1,Q2,Q3,and Q4 groups after discharge were 11.0%,4.9%,3.7%,and 1.2%,respectively.Kaplan-Meier survival curve analysis showed that the l-year survival rate in discharged patients with persistent hypochloriemia was lower than those with transient hypochloriemia(P=0.025).Multivariate Cox regression analysis showed that the mean blood chloride was an independent risk factor for 1-year all-cause death in HFpEF patients(HR=1.29,95%CI:1.10-1.42,P=0.033).The area under the ROC curve of the average blood chlorine during hospitalization and the blood chlorine on admission for predicting 1-year all-cause death were 0.819 and 0.698 respectively.Conclusion:The average blood chlorine level during hospitalization is correlated with the l-year poor prognosis of HFpEF patients,and its predictive value for the l-year prognosis is greater than the single admission blood chlorine level.

关 键 词：心力衰竭 射血分数保留型 低氯血症 预后 

分 类 号：R541.6[医药卫生—心血管疾病]