血钾水平预测 2 类 PH 患者严重程度及住院时间的临床研究
Prediction of Severity and Length of Hospital Stay in Patients with Group 2 Pulmonary Hypertension based on Serum Potassium Level
背景 肺动脉高压（PH）常由左心脏疾病所致（2类PH），早期诊断困难，病死率高，钾通道功能障碍是 PH 的标志，但该病的流行病学数据仍不清楚，钾离子对肺动脉高压的影响尚不明确。目的 探讨 2 类PH患者的血钾水平与心肌标志物、超声心动图指标及住院时间的关系，评价血钾水平对 2 类 PH 严重程度的预测价值，为临床诊断治疗提供理论依据。方法 回顾性收集 2020 年 1 月—2021 年 12 月在山西医科大学第一医院诊断为 2 类 PH的400例成年住院患者的病例资料：（1）一般资料：性别、年龄、BMI、住院时间、吸烟情况及吸烟指数（SI）、饮酒史。（2）基础病（糖尿病、高血压）。（3）实验室资料：血钾、心肌标志物（降钙素原、N 端 -B 型钠尿肽前体、肌钙蛋白 I、肌钙蛋白 T、肌酸激酶同工酶）、超声心动图指标（左心房前后径、右心室前后径、右心房面积、左心室射血分数、缩短分数、三尖瓣反流峰值流速、肺动脉收缩压）。依据血钾水平将纳入患者分为 3 组：5.5 mmol/L 组（n=3）。采用 Spearman 秩相关分析探讨血钾水平与心肌标志物、超声心动图指标的相关性；采用 Log-rank（Mantel-Cox）检验比较不同血钾水平患者的出院率；通过绘制受试者工作特征曲线（ROC 曲线）评价血钾对 2 类 PH 严重程度的预测价值。结果 >5.5 mmol/L 组患者降钙素原及 N 端 -B 型钠尿肽前体（NT-proBNP）高于 <3.5 mmol/L 组的患者水平（P<0.05）。相关性分析结果表明，血钾水平与 NT-proBNP（rs=0.133）、三尖瓣反流峰值流速（rs=0.017）、肺动脉收缩压（rs=0.126）呈正相关（P<0.05）。将血钾水平进一步分为 5.5 mmol/L，以深入研究血钾水平与患者住院时间的关系。Log-rank（Mantel-Cox）检验结果显示，对于大于平均住院水平的 2 类患者，不同血钾水平患者（5.5 mmol/L）的累积住院率比较，差异有统计学意义（P=0.022）。ROC 曲线结果显示，血钾对非轻度 PH 的诊断价值〔ROC 曲线下面积（AUC）= 0.577，截断值为 3.91 mmol/L，灵敏为64.7%，特异度为 52.5%〕与 NT-proBNP 的诊断价值相近（AUC=0.585，截断值为 1 070.69 pg/mL，灵敏度为 78.1%，特异度为 39.6%），可有效预测 2 类 PH 的严重程度。结论 血钾水平可预测 2 类 PH 患者的严重程度及住院时间，干预血钾水平可能是防治 PH 的新途径之一。
Background Pulmonary hypertensionPH is often caused by left heart diseasegroup 2 PHwhich is difficult to diagnose early and with a high mortality rate. Potassium channel dysfunction is a marker of PHhoweverthe epidemiological data of the disease and the effect of potassium ions on PH still remain unclear. Objective To investigate the correlation of serum potassium level with myocardial markersechocardiographic indicators and length of hospital stay in patients with group 2 PHand evaluate the predictive value of serum potassium levels for the severity of group 2 PHso as to provide the oretical basis for clinical diagnosis and treatment. Methods The clinical data of 400 adult inpatients diagnosed with group 2 PH in the First Hospital of Shanxi Medical University from January 2020 to December 2021 were retrospectively collected as follows1 general datagenderagebody mass indexBMIlength of hospital staysmoking statussmoking indexSIand drinking history2underlying diseasesdiabetes mellitushypertension3 laboratory dataserum potassium levelmyocardial markersprocalcitoninN-terminal pro-brain natriuretic peptideNT-proBNPcardiac troponin Icardiac troponin Tcreatine kinase-MBechocardiographic indicatorsleft atrial diameterright ventricular diameterright atrial arealeft ventricular ejection fractionshortening fractionpeak tricuspid regurgitation velocitypulmonary artery systolic pressure. The patients were divided into 5.5 mmol/L groupn=3according to the serum potassium level.Spearman correlation analysis was used to explore the correlation of serum potassium level with myocardial markers and echocardiographic indicators. Log-rank Mantel-Cox test was used to compare the discharge rate of patients with different serum potassium levels. Receiver operating characteristic curve ROC curve was plotted to evaluate the predictive value of serum potassium level for the severity of group 2 PH. Results Procalcitonin and NTproBNP levels of patients in the hyperkalemia group were significantly higher than the hypokalemia groupP<0.05. Correlation analysis showed that serum potassium level was positively correlated with NT-proBNPrs=0.133peak tricuspid regurgitation velocityrs=0.017 and pulmonary artery systolic pressure PASPrs=0.126P<0.05. Serum potassium level was further classified as 5.5 mmol/L to investigate its relationship with length of hospital stay in depth. Log-rank Mantel-Cox testresults showed that for group 2 PH patients greater than average hospitalization levelsthere was a significant difference in cumulative hospitalization rates among patients with different serum potassium levels5.5 mmol/LP=0.022. ROC analysis showed that the diagnostic value of serum potassium level for non-mild PHAUC=0.577cut-off value=3.91 mmol/Lsensitivity=64.7%specificity=52.5% was similar to that of NT-proBNPAUC=0.585cut-off value=1 070.69 pg/mLsensitivity=78.1%specificity=39.6%which can effectively predict the severity of group 2 PH. Conclusion Serum potassium level can predict the severity of group 2 PH and the length of hospital stay. Intervention of serum potassium levels may be one of the new approach to prevent and treat PH.
郭耘廷、侯晓敏、施熠炜、郑志发、常铭洋、孙琳、白剑英、秦小江、赵旭
10.12114/j.issn.1007-9572.2023.0036
临床医学内科学
肺动脉高压血钾超声心动图住院时间预测价值
Pulmonary arterial hypertensionSerum potassiumEchocardiographyHospital stayPredictive value
郭耘廷,侯晓敏,施熠炜,郑志发,常铭洋,孙琳,白剑英,秦小江,赵旭.血钾水平预测 2 类 PH 患者严重程度及住院时间的临床研究[EB/OL].(2023-07-05)[2025-08-02].https://chinaxiv.org/abs/202308.00048.点此复制
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