血清氯离子水平与心力衰竭患者住院死亡风险的相关性  

Association Between Serum Chloride and In-hospital Mortality Risk Among Patients with Heart Failure

作　　者：吴雷 魏小云 曾庆春 WU Lei;WEI Xiaoyun;ZENG Qingchun(Second Department of Cardiology,the Fifth Clinical Medical College of Henan University of Traditional Chinese Medicine(Zhengzhou People’s Hospital),Zhengzhou 450000,China;Department of Cardiology,Nanfang Hospital,Southern Medical University,Guangzhou 510080,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)心内二科,河南郑州450000 [2]南方医科大学南方医院心内科,广东广州510080

出　　处：《河南医学研究》2024年第13期2318-2323,共6页Henan Medical Research

摘　　要：目的探讨入院时血清氯离子水平与心力衰竭患者住院死亡风险的相关性。方法选择2018年1月至2021年12月于郑州人民医院心内科住院心力衰竭患者临床资料1098例,根据入院时血清氯离子水平以三分位法分为70~103 mmol·L^(-1)组(低分位组,390例),103~105 mmol·L^(-1)组(中分位组,321例),105~125 mmol·L^(-1)组(高分位组,387例)。主要终点事件为住院死亡。采用logistic回归探讨入院时血清氯离子水平与住院死亡风险之间的相关性。结果氯离子水平较低的心力衰竭患者(<103 mmol·L^(-1)组)倾向于有较高的N-末端脑钠肽前体、谷丙转氨酶、肌酐及利尿剂使用量(P<0.05)。单因素logistic回归分析结果显示,相较于低分位组,中分位组与高分位组与心力衰竭住院死亡风险降低相关[OR(95%CI)为0.40(0.14~0.90),P=0.020;OR(95%CI)为0.36(0.10~0.82),P<0.001]。相较于低分位组,高分位组与心力衰竭再住院风险降低相关[OR(95%CI)为0.50(0.29~0.86),P=0.013]。进一步多因素logistic回归分析发现,高分位组患者的血清氯离子水平与心力衰竭住院死亡风险降低相关[OR(95%CI)为0.10(0.01~0.98),P=0.049];中分位组差异无统计学意义;多因素分析中血清氯离子与心力衰竭再住院风险差异无统计学意义。剂量反应曲线显示血清氯离子在105~110 mmol·L^(-1)情况下住院死亡风险最低。结论入院时较高的血清氯离子水平与心力衰竭患者住院死亡率降低相关。Objective To investigate the association between serum chloride levels on admission and the risk of in-hospital mortality in patients with heart failure.Methods A total of 1098 patients with heart failure in the Department of Cardiology of Zhengzhou People’s Hospital from January 2018 to December 2021 were selected.Patients were divided into three groups based on their serum chloride levels on admission:70-103 mmol·L^(-1) group(low quartile group,390 cases),103-105 mmol·L^(-1) group(middle quartile group,321 cases),and 105-125 mmol·L^(-1) group(high quartile group,387 cases).The primary endpoint was in-hospital death.Logistic regression analysis was performed to examine the association between serum chloride levels on admission and the risk of in-hospital mortality.Results Patients with heart failure and lower serum chloride levels(<103 mmol·L^(-1) group)had higher levels of NT-proBNP,glutamate,creatinine and diuretic use(P<0.05).Univariate logistic regression analysis showed that the middle and high quartile groups had a reduced risk of in-hospital death from heart failure compared with the low quartile group[OR(95%CI)was 0.40(0.14-0.90),P=0.020;OR(95%CI)was 0.36(0.10-0.82),P<0.001],respectively.Compared with the low tertile group,the high tertile group was associated with a reduced rehospitalisation risk for heart failure[OR(95%CI)was 0.50(0.29-0.86),P=0.013].In addition,multifactorial logistic regression analysis showed that patients in the high quartile group had a reduced risk of in-hospital death from heart failure[OR(95%CI)was 0.10(0.01-0.98),P=0.049].However,the median group did not reach statistical significance.Statistical significance was no longer significant between serum chloride and rehospitalisation risk for heart failure in the multifactorial analysis.The dose-response curve showed the lowest risk of in-hospital death at serum chloride levels of 105-110 mmol·L^(-1).Conclusion Elevated serum chloride levels on admission are associated with reduced in-hospital mortality in patients with hear

关 键 词：心力衰竭 血清氯离子 住院死亡风险 

分 类 号：R541.6[医药卫生—心血管疾病]