【作者】 吴莹；

【导师】 黄全跃；

【作者基本信息】 中南大学 ， 心血管内科学， 2008， 硕士

【摘要】 目的通过病例回顾的方法研究低钠血症与慢性心力衰竭患者心脏功能和临床预后的关系。方法收集2003年7月-2004年8月期间在中南大学湘雅二医院心内科住院诊断为慢性心力衰竭(CHF)的患者806例,根据患者血钠水平分为2组,血钠≥135mmol/L归为正常血钠组,血钠＜135mmol/L归为低血钠组。临床资料收集采用电脑分类查询结合人工病历抄录的方法,记录患者一般临床资料、基础心脏病因、伴随疾病、实验室检查结果、心脏彩超检查结果、住院治疗的转归。用多因素Logistic回归分析血钠水平与CHF患者心功能及临床预后的关系。结果1、研究对象中低钠血症为102例,占所有病例的12.66%。2、低血钠组的高血压病、心肌病所致心力衰竭的比例高于正常血钠组,差异有统计学意义(P＜0.05)。两组间其他人口统计学资料及冠心病、瓣膜病、糖尿病病因学方面的资料均无统计学差异(P＞0.05)。3、低血钠组中的血氯水平显著降低(P＜0.05),白细胞计数、血尿素氮、肌酐水平显著升高(P＞0.05)。两组间血钾、尿酸、空腹血糖水平、血红蛋白浓度及血小板计数比较差异无统计学意义(P＞0.05)。4、二维超声心动图(Ultrasonic Cardiography,UCG)测定的两组左房内径、左室舒张末期内径及左室射血分数的差异有统计学意义(P＜0.05),CHF伴发低钠血症的患者左房、左室内径显著增大,射血分数明显减低。患者血钠水平与LVEF正相关,与LAD、LVDD负相关。5、NYHA心功能评级比较,两组差异有显著性意义(P＜0.05);多分类Logistic回归分析结果显示患者血钠水平是心功能评级的重要影响因素(P＜0.05)。6、两组患者的临床预后差异有统计学意义(P＜0.05)。多分类Logistic回归分析,结果显示血钠水平是临床预后的重要影响因素(P＜0.05)。7、患者血钠水平、NYHA心功能评级与临床预后的相关性分析,结果显示组别、NYHA心功能评级都是临床预后的重要影响因素(P＜0.01)。以NYHA心功能评级和临床预后两指标比较看,其拟合优度检验p=0.964,相关模型拟合效果较好,两指标存在相关性(P＜0.01),提示随心功能评级的增加,临床预后亦相应恶化。结论1、CHF患者的血钠水平是患者心脏功能(NYHA心功能评级、LAD、LVDD、LVEF)的重要影响因素,血钠水平越低,其心脏功能越差。2、CHF患者的血钠水平、心脏功能是影响患者临床预后的重要因素,其血钠水平越低,NYHA心脏功能越差,临床预后越差。更多还原

【Abstract】 ObjectivesThe aims of this study were to investigate the relationships between hyponatremia and the cardiac function and prognostic status of the patients with chronic heart failure(CHF).MethodsEight hundred and six subjects were collected from the patients with CHF who were hospitalized in the second Xiangya hospital of central south university from July 2003 to August 2004.The patients with CHF were divided into 2 groups according to serum sodium levels:normal serum sodium group(Na≥135mmol/L)and lower serum sodium group(Na＜135 mmol/L).The methods of computerized sorting accompanized with a excerpting medical records were used to collect the clinical data.Demographic data and general clinical data including underlying cardiac diseases,concomitant diseases,clinical chemistry, echocardiogram results and residential treatment regimens were all recorded.The correlations of serum sodium levels with NYHA cardiac function class as well as prognostic status in patients with CHF were analyzed by multi-factor logistic statistical method.Results1.One hundred and two cases were concomitant with hyponatremia, accounting for 12.66%of study population.2 The proportion of hypertension and cardiomyopathy in CHF with hyponatremia group was significantly higher than that in CHF with normal serum sodium group(p＜005),While there were no statistical differences between two groups in general information(including age, gender,smoking,drinking,BMI,family history of cardiovascular disease) and the history of coronary heart disease,valvular disease and diabetes mellitus(P＞0.05).3.Serum chlorine was reduced significantly in hyponatremia group(P＜0.05)and the white blood cell count,the levels of serum urea nitrogen and creatinine increased significantly in the hyponatremia group(P＜0.05).The differences of levels of the serum potassium,uric acid and fasting blood glucose(FBS),hemoglobin(Hb)and platelet(PLT) count were not statistically significant between two groups(P＞0.05).4.Ultrasonic Cardiography revealed the left atrial diameter(LAD), the left ventricular end-diastolic diameter(LVDD)and the left ventricular ejection fraction(LVEF)differs in two groups(P＜0.05).LAD、LVDD increased remarkably,but LVEF decreased significantly in the patients of CHF concomitant with hyponatremia.The level of serum natrium was positively related to the LAD and LVEFand negatively related to the LVDD,respectively. 5.There was a significant difference in NYHA cardiac function class between two groups(P＜0.05).The correlation of serum sodium levels with the cardiac function class in CHF patients were analyzed by multi-factor logistic statistical method,the serum sodium levels may be the key index in cardiac function class(P＜0.05).6.The prognosis of the lower serum sodium group was worse than the other group(P＜0.05).The relationships between serum sodium levels and the cardiac function rating in CHF patients were analyzed by multi-factor logistic statistical method,the serum sodium levels may be the key index in the prognosis of CHF(P＜0.05).7.The correlations among serum sodium levels,the NYHA cardiac function class and prognostic value were analyzed,showing that group and NYHA cardiac function class were important factors of the clinical prognosis of patients(P＜0.01).Considering cardiac function class and prognostic status,the goodness-of-fit test and correlating test of them were good.It is concluded that the prognosis aggravates as the NYHA cardiac function class elevates.Conclusions1.Serum sodium levels may be the key index in cardiac function of CHF patients.The lower serum sodium levels were,the worse cardiac function were.2.Serum sodium levels and cardiac function were important factors of the clinical prognosis of patients.The lower serum sodium levels and the worse cardiac function were,the worse prognosis were.更多还原