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目的探讨低钠血症及传统心血管危险因素对重度慢性心力衰竭(CHF)患者预后的预测价值。方法收集2014年4月-2015年1月于新疆维吾尔自治区人民医院住院,按纽约心脏病协会(NYHA)法分为心功能Ⅳ级189例CHF患者为研究对象,对其随访6月,通过电话访问及回顾患者再入院就诊的医疗记录方式记录随访信息。记录的全因死亡指患者在随访期间死亡,包括心因性死亡及非心因性死亡。按随访结果将患者分为事件组和对照组,采用多因素logistic回归分析低钠血症及心血管传统危险因素对重度CHF患者预后的预测价值。结果事件组入院低钠血症发生率(21.9%vs.12.0%,P=0.027),糖尿病发生率(48.4%vs.28.0%,P=0.006)、血清N末端脑钠尿肽前体(NT-proBNP)[(1 841.2±231.5)pg/ml vs.(1 426.5±164.3)pg/ml,P<0.001)明显高于对照组。多因素logistic回归分析显示,低钠血症(OR=1.624,95%CI:1.024~4.225,P=0.036),高血清NT-proBNP水平(OR=1.214,95%CI:1.178~4.460,P<0.001)、糖尿病(OR=2.415,95%CI:1.321~4.643,P=0.038)是重度慢性心衰患者6月内全因死亡发生的独立危险因素。结论入院时低钠血症、高血清NT-proBNP水平、糖尿病是重度慢性心衰患者6月随访期内全因死亡的独立危险因素。
Objective To investigate the prognostic value of hyponatremia and traditional cardiovascular risk factors in patients with severe chronic heart failure (CHF). Methods A total of 189 CHF patients with grade IV of cardiac function were enrolled in this study from April 2014 to January 2015 in People’s Hospital of Xinjiang Uygur Autonomous Region. According to the New York Heart Association (NYHA) method, patients were followed up for 6 months. To visit and review the medical record of patients re-admission treatment record follow-up information. Recorded all-cause death refers to the death of patients during follow-up, including both causal and non-causal deaths. According to the follow-up results, the patients were divided into incident group and control group. Multivariate logistic regression was used to analyze the predictive value of hyponatremia and cardiovascular traditional risk factors in patients with severe CHF. Results The incidence of hyponatremia (21.9% vs. 12.0%, P = 0.027), incidence of diabetes (48.4% vs.28.0%, P = 0.006), serum N-terminal pro brain natriuretic peptide (1 841.2 ± 231.5) pg / ml vs. (1 426.5 ± 164.3) pg / ml, P <0.001) was significantly higher than that of the control group. Multivariate logistic regression analysis showed that the level of NT-proBNP in high serum (OR = 1.214, 95% CI: 1.178-4.460, P < 0.001). Diabetes mellitus (OR = 2.415, 95% CI: 1.321 ~ 4.643, P = 0.038) was an independent risk factor for all-cause mortality in patients with severe chronic heart failure within 6 months. Conclusions Hyponatremia, high serum NT-proBNP level and diabetes mellitus are independent risk factors for all-cause mortality in patients with severe chronic heart failure during the follow-up period of 6 months.