| 失代偿心力衰竭患者血钠水平与三尖瓣收缩期位移及肾小球滤过率的关系 |
| 投稿时间：2016-08-25 修订日期：2017-06-20 点此下载全文 |
| 引用本文：杨晶敏,张洁钰,张菲斐.失代偿心力衰竭患者血钠水平与三尖瓣收缩期位移及肾小球滤过率的关系[J].医学研究杂志,2017,46(11):116-120 |
| DOI：
10.11969/j.issn.1673-548X.2017.11.028 |
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| 中文摘要:目的 研究失代偿心力衰竭患者血钠水平与三尖瓣收缩期位移及肾小球滤过率的关系。方法 选取经超声心动图证实的左心室射血分数（LVEF） ≤ 45%，且NYHA心功能分级在Ⅲ~Ⅳ级的失代偿心力衰竭患者116例，入院当天收集身高、体重、收缩压/舒张压等一般资料，第2日空腹抽血测定血电解质，尿素及肌酐等生化指标；血清N末端脑钠肽前体（NT-proBNP）水平。选用改良MDRD方程计算肾小球滤过率估算值（eGFR）。入院48h内行超声心动图测定三尖瓣收缩期位移（TAPSE）、左心室舒张末期内径（LVED）、右心室舒张末期内径（RVED）、肺动脉收缩压（PASP）及左心室射血分数（LVEF）。根据血清钠水平将全部入选病例分为低钠血症组（血清钠 ≤ 135mmol/L，n=52）与正常血钠组（血清钠>135mmol/L，n=64）。对比两组上述一般资料、生化指标以及超声学指标差异。此外，对低钠血症组，以血钠水平分别与TAPSE、eGFR进行直线相关分析，同时将TAPSE与eGFR进行直线相关分析。结果 ①低钠血症组NT-proBNP显著高于正常血钠组（P=0.032），TAPSE降低及eGFR下降与血钠正常组相比，差异均有统计学意义（P=0.015，P=0.004）；②直线相关分析显示，低钠血症组其血钠水平与TAPSE降低及eGFR下降均呈正相关（r=0.785；r=0.702）。同时，低钠血症组TAPSE下降与eGFR下降亦呈正相关（r=0.630）。结论 失代偿心力衰竭患者低钠血症与TAPSE下降及eGFR降低之间密切相关，可作为早期识别此类患者发生肾功能恶化的简便而实用临床预测指标。 |
| 中文关键词:失代偿心力衰竭 低钠血症 三尖瓣收缩期位移 肾小球滤过率 |
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| Association Between Serum Sodium Level and Tricuspid Annular Plane Systolic Excursion and Estimated Glomerular Filtration Rate in Patients with Decompensated Heart Failure |
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| Abstract:Objective To investigate the association between serum sodium level and tricuspid annular plane systolic excursion (TAPSE) and estimated glomerular filtration rate (eGFR) in patients with decompensated heart failure.Methods Totally 116 in-patients with decompensated heart failure who had left ventricular ejection fraction (LVEF) ≤ 45% confirmed by echocardiogram and belonged to Ⅲ-Ⅳ degree of NYHA were enrolled. We collected height, weight, systolic/diastolic blood pressure and other general information on the first day of hospitalization. The dates of serum electrolyte, urea,creatinine and N-terminal pro-brain natriuretic peptide(NT-proBNP) level were detected in the second day of hospitalization on an empty stomach. Then eGFR were obtained by the modified MDRD equation. Tricuspid annular plane systolic excursion (TAPSE),left ventricular end diameter(LVED), right ventricular end diameter(RVED), pulmonary arterial systolic pressure(PASP) and left ventricular ejection fraction(LVEF) all were measured by echocardiography within 48 hours of hospitalization.All the patients were divided into two groups, the hyponatremia group and non-hyponatremia group, according to the serum sodium level (serum sodium ≤ 135mmol/L was defined as hyponatremia, n=52; serum sodium>135mmol/L was defined as non-hyponatremia, n=64). The NT-proBNP, LVEF, TAPSE and eGFR were compared between the two groups. Besides, for the hyponatremia group, the relevance between serum sodium level and TAPSE, eGFR were respectively analyzed. And we also analyzed the relevance between TAPSE and eGFR.Results ① The level of NT-proBNP in hyponatremia group was higher than non-hyponatremia group with statistical significance(P=0.032),while TAPSE and eGFR were lower than non-hyponatremia group with statistical significance(P=0.015, P=0.004).② Logistic regression analysis results showed that serum sodium level was positively correlated with the decrease of both TAPSE and eGFR (r=0.785,r=0.702).Meanwhile the decrease of TAPSE was also positively correlated with the decrease of eGFR(r=0.630).Conclusion Hyponatremia was positively correlated with the decrease of both TAPSE and eGFR in patients with decompensated heart failure. And hyponatremia maybe was considered as an easy and practical predictor for identifying those patients who would experience worsening renal function in early state. |
| keywords:Decompensated heart failure Hyponatremia Tricuspid annular plane systolic excursion (TAPSE) Estimated glomerular filtration rate (eGFR) |
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