体质指数对心力衰竭合并低钠血症患者预后的影响

摘要

Objective To analyze the influence of body mass index (BMI) on the prognosis in patients with heart failure (HF) complicated by hyponatremia.Methods The patients (n=79, male 20 and female 59) were continuously chosen from the Beijing Rehabilitation Hospital and Beijing Mentougou District Hospital from Jan. 2014 to Dec. 2016. All patients were divided into BMI<18.5 kg/m2 group (n=38) and BMI≥18.5 kg/m2 group (n=41). The medical materials were collected from the patients and analyzed. All patients were followed up for one year for recording patients' survival situation.Results The condition of disease was more serious, blood pressure and left ventricular ejection fraction (LVEF) were lower, and NYHA grading and brain natriuretic peptide (BNP) were higher in BMI<18.5 kg/m2 group than those in BMI≥18.5 kg/m2 group. There were 7 patients died during hospitalization, and hospitalization-case fatality rate was 8.9% (7/79). The all-cause mortality was 21.5% (17/79) and mortality due to aggravated HF was 16.5% (13/79) during 1-year follow-up period. The results of Kaplan-Meier survival analysis showed that accumulated hospitalization-case fatality rate, accumulated all-cause mortality of 1-year follow-up period and accumulated HF mortality of 1-year follow-up period were significantly higher in BMI<18.5 kg/m2 group than those in BMI≥18.5kg/m2 group (allP<0.01). After correcting the levels of BNP, LVEF, left ventricular end-diastolic inner diameter (LVEDD), systolic blood pressure (SBP) and diastolic blood pressure (DBP), low level of BMI was the important influence factor of death in patients with HF complicated by hyponatremia (HR=4.221, 95%CI: 1.011~17.626).Conclusion The lower BMI is an influence factor of prognosis in patients with HF complicated by hyponatremia.%目的 分析体质指数(BMI)对心力衰竭(心衰)合并低钠血症患者预后的影响.方法 连续入选2014年1月~2016年12月于北京市康复医院和门头沟区医院住院的心衰合并低钠血症患者79例,其中男性20例,女性59例.分为BMI<18.5 kg/m2组(38例)和BMI≥18.5 kg/m2组(41例).收集和分析患者病历资料,出院后随访1年,记录生存情况.结果 与BMI≥18.5 kg/m2组比较,BMI<18.5 kg/m2组入院时病情较重,血压和左室射血分数(LVEF)偏低,纽约心脏学会心功能分级、脑钠肽(BNP)较高,差异有统计学意义(P均<0.05).住院期间共7例患者死亡,住院病死率为8.9%(7/79).随访1年的全因死亡率为21.5%(17/79),心衰加重死亡率为16.5%(13/79).Kaplan-Meier生存分析结果显示,BMI<18.5 kg/m2组患者的累积住院死亡率、随访1年的累积全因死亡率及随访1年的累积心衰死亡率均明显高于BMI≥18.5 kg/m2组(P均<0.01).在校正BNP、LVEF、左室舒张末内径、收缩压和舒张压水平后,低BMI是心衰合并低钠血症患者死亡的重要影响因素(HR=4.221,95%CI:1.011~17.626).结论 低体质指数是心力衰竭合并低钠血症患者预后的影响因素.