左心疾病相关肺动脉高压患者血钠水平与住院时间的关系
Relationship between Serum Sodium Levels and Length of Hospital Stay in Patients with Pulmonary Hypertension associated with Left Heart Disease
背景 左心疾病相关肺动脉高压（PH-LHD）是肺动脉高压（PH）中最常见的一种。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 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（136 例）、血钠 140~145 mmol/L（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=-0.176）、NT-proBNP（r=-0.135）、右心室前后径（r=-0.110）、肺动脉收缩压（r=-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（χ2=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 140~145 mmol/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）患者住院时间延长的风险均升高。结论 血钠水平与 PH-LHD 严重程度密切相关，血钠水平降低是 PH-LHD 患者住院时间的独立危险因素，是一种潜在的治疗考虑因素，为 PH-LHD 的诊疗及医院周转提供新策略。
Background Pulmonary hypertensionPHassociated with left heart diseasePH-LHDis 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 peptideNT-proBNPand echocardiographic indexes in PH-LHD patientsand evaluate the effect of serum sodium on the severity and length of stay of PH-LHDso 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/Lserum sodium <135 mmol/L is hyposodiumthe patients were divided into 3 groups<135 mmol/L groupn=50135-139 mmol/Ln=136and 140-145 mmol/Ln=174. Spearman correlation analysis was used to explore the correlation of serum sodium level with length of hospital stayNT-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 Agelength of stayNT-proBNPleft atrial diameter right atrium area left ventricular ejection fraction and shortening fraction of PH-LHD patients in 3 groups were comparedand the differences were statistically significantP<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 groupP<0.05. Spearman correlation analysis showed that serum sodium level was negatively correlated with length of stayr=-0.176NTproBNPr=-0.135right ventricular diameterr=-0.110and pulmonary artery systolic pressurer=-0.105in PH-LHD patientsP<0.05. The Kaplan-Meier survival showed that there were statistically significant differences between the length of hospital stay among the three groups of PH-LHD patients with different serum sodium levels. Binary Logistic regression analysis showed that increased serum sodium level was a protective factor for longer hospital stay in PH-LHD patients after correcting each control variableOR=0.91695%CI=0.859-0.977P=0.008. The risk of prolonged hospitalization was elevated in patients with serum sodium <135 mmol/L and those with serum sodium 135-139 mmol/L compared with patients with serum sodium 140- 145 mmol/L. Conclusion Serum sodium level is closely related to the severity of PH-LHDand decreased serum sodium level is an independent risk factor for the length of hospital stay in PH-LHD patients. It is a potential therapeutic considerationproviding new strategies for the diagnosis and treatment of PH-LHD and hospital turnover.
郭耘廷、赵旭、聂继盛、孙琳、施熠炜、董霖、侯晓敏、秦小江
10.12114/j.issn.1007-9572.2023.0889
临床医学内科学
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
郭耘廷,赵旭,聂继盛,孙琳,施熠炜,董霖,侯晓敏,秦小江.左心疾病相关肺动脉高压患者血钠水平与住院时间的关系[EB/OL].(2024-03-27)[2025-08-02].https://chinaxiv.org/abs/202403.00389.点此复制
评论