左心疾病相关肺动脉高压患者血钠水平与住院时间的相关性研究  

Relationship between Serum Sodium Levels and Length of Hospital Stay in Patients with Pulmonary Hypertension associated with Left Heart Disease

作　　者：孙琳 施熠炜[2] 侯晓敏[3] 郭耘廷 赵旭 董霖 聂继盛[1] 秦小江[1] SUN Lin;SHI Yiwei;HOU Xiaomin;GUO Yunting;ZHAO Xu;DONG Lin;NIE Jisheng;QIN Xiaojiang(School of Public Health,Shanxi Medical University,Taiyuan 030001,China;First Hospital of Shanxi Medical University,Taiyuan 030001,China;College of Basic Medical College,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学公共卫生学院,山西省太原市030001 [2]山西医科大学第一医院,山西省太原市030001 [3]山西医科大学基础医学院,山西省太原市030001

出　　处：《中国全科医学》2025年第9期1065-1071,共7页Chinese General Practice

基　　金：国家自然科学基金面上项目(82373622);国家自然科学基金青年基金项目(82204042);国家卫生健康委员会尘肺病重点实验室开放课题(YKFKT006,NHC202307);山西省留学人员科技活动择优资助项目重点项目(20220019);山西省科技合作交流专项项目区域合作项目(202204041101022);山西省科技创新人才团队专项项目(202304051001038);中央级公益性科研院所科研业务项目(2020-PT320-005)。

摘　　要：背景左心疾病相关肺动脉高压(PH-LHD)是肺动脉高压(PH)中较常见的一种。研究表明,血钠水平与1类PH的严重程度和不良预后相关,然而,其对PH-LHD的影响鲜有报道。目的探讨PH-LHD患者的血钠水平与N末端脑利钠肽前体(NT-proBNP)、超声心动图指标的关系,评价血钠水平对PH-LHD严重程度及住院时间的影响,为PH-LHD患者的临床诊疗及提高医院周转率提供理论依据。方法回顾性收集2020年1月—2022年2月在山西医科大学第一医院住院的360例PH-LHD患者的临床资料,依据患者的中位血钠水平139 mmol/L(血钠<135 mmol/L为低血钠)将患者分为3组:血钠<135 mmol/L组(50例)、血钠135~139 mmol/L组(136例)、血钠140~145 mmol/L组(174例)。采用Spearman秩相关分析探讨血钠水平与住院时间、NT-proBNP及超声心动图指标的相关性;采用Kaplan-Meier生存曲线分析比较不同血钠水平PH-LHD患者的住院时间;采用二元Logistic回归分析探讨血钠水平对PH-LHD患者住院时间的影响。结果3组PH-LHD患者年龄、住院时间、NT-proBNP、左心房前后径、右心房面积、左心室射血分数、缩短分数比较,差异有统计学意义(P<0.05);其中血钠140~145 mmol/L组患者的住院时间、NT-proBNP低于血钠<135 mmol/L组及血钠135~139 mmol/L组(P<0.05)。Spearman秩相关分析结果显示,PH-LHD患者血钠水平与住院时间(r_(s)=-0.176)、NT-proBNP(r_(s)=-0.135)、右心室前后径(r_(s)=-0.110)、肺动脉收缩压(r_(s)=-0.105)均呈负相关(P<0.05)。Kaplan-Meier生存曲线分析结果显示,3组血钠水平的PH-LHD患者住院时间比较,差异有统计学意义(χ^(2)=12.469,P=0.002)。二元Logistic回归分析校正各控制变量后结果显示,血钠水平升高是PH-LHD患者住院时间延长的保护因素(OR=0.916,95%CI=0.859~0.977,P=0.008);与血钠140~145mmol/L患者相比,血钠<135 mmol/L(OR=2.268,95%CI=1.049~4.903,P=0.037)及血钠135~139 mmol/L(OR=2.056,95%CI=1.163~3.635,P=0.013)患者住院时间延�Background Pulmonary hypertension(PH)associated with left heart disease(PH-LHD)is the most common form of PH.Studies have shown that serum sodium is associated with the severity and poor prognosis of group 1 PH,but the effect of serum sodium on PH-LHD has rarely been reported.Objective To investigate the relationship between serum sodium and N-terminal pro-brain natriuretic peptide(NT-proBNP)and echocardiographic indexes in PH-LHD patients,and evaluate the effect of serum sodium on the severity and length of stay of PH-LHD,so as to provide theoretical basis for clinical diagnosis and treatment of PH-LHD patients and improvement of hospital turnover.Methods The clinical data of 360 adult inpatients diagnosed with PH-LHD in the First Hospital of Shanxi Medical University from January 2020 to February 2022 were collected.According to the median serum sodium of 139 mmol/L(serum sodium<135 mmol/L is hyposodium),the patients were divided into 3 groups:<135 mmol/L group(n=50),135-139 mmol/L group(n=136)and 140-145 mmol/L group(n=174).Spearman correlation analysis was used to explore the correlation of serum sodium level with length of hospital stay,NT-proBNP and echocardiographic indicators.Kaplan-Meier was used to compare the length of hospital stay of PH-LHD patients with different serum sodium levels.Binary Logistic regression analysis was used to investigate the effect of serum sodium levels on the length of hospital stay in PH-LHD patients.Results Age,length of stay,NT-proBNP,left atrial diameter,right atrium area,left ventricular ejection fraction and shortening fraction of PH-LHD patients in 3 groups were compared,and the differences were statistically significant(P<0.05).The length of hospitalization and NT-proBNP of patients in the serum sodium 140-145 mmol/L group were lower than those in the serum sodium<135 mmol/L group and the serum sodium 135-139 mmol/L group(P<0.05).Spearman correlation analysis showed that serum sodium level was negatively correlated with length of stay(r_(s)=-0.176),NT-proBNP(r_(s)=-0.1

关 键 词：肺动脉高压 左心疾病相关肺动脉高压 血钠 超声心动图 住院时间 Logistic模型 

分 类 号：R541.5[医药卫生—心血管疾病]