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目的探讨急性心肌梗死(AMI)低钠血症的预后价值。方法对我院心内科CCU病房2003年1月至2004年12月670例资料完整的AMI患者进行了回顾性分析,根据患者入院后即刻、24、48h血清钠离子浓度最低值共分为三组:A组Na+≥135mmol/L;B组Na+120~135mmol/L;C组Na+≤120mmol/L。比较各组心肌酶、心肌梗死面积、心功能及住院病死率。结果(1)三组住院病死率分别为:A组7·6%(17/225),B组8·1%(34/421),C组33·3%(8/24),C组分别与A组和B组比较,差异具有统计学意义(P<0·05)。(2)三组肌酸激酶(CK),肌酸激酶同工酶(CK-MB)及心肌梗死面积(S)进行比较,C组分别与A组和B组比较差异有统计学意义(P<0·05)。(3)住院期间死亡59例,存活611例,存活组与死亡组血清钠离子浓度分别为(133·00±5·25)mmol/L和(122·00±7·25)mmol/L,两组比较差异有统计学意义(P<0·01)。(4)对AMI后30天住院期间死亡危险因素进行多因素logistic回归分析,血清钠离子浓度降低与AMI后30天住院期间病死率相关。并且30天住院期间病死率随着血清钠离子浓度降低而升高。结论低钠血症可能是AMI预后不良的标志之一。
Objective To investigate the prognostic value of hyponatremia in acute myocardial infarction (AMI). Methods A retrospective analysis was performed on 670 cases of AMI with complete data from January 2003 to December 2004 in CCU ward of Cardiology Department of our hospital. According to the lowest level of serum sodium ion at 24 and 48 hours immediately after admission, patients were divided into three groups : A group Na + ≥135mmol / L; B group Na + 120 ~ 135mmol / L; C group Na + ≤120mmol / L. The myocardial enzymes, myocardial infarct size, cardiac function and in-hospital mortality of each group were compared. Results (1) The in-hospital mortality of the three groups were 7.6% (17/225) in group A, 8.1% (34/421) in group B, 33.3% (8/24) in group C, Compared with group A and group B respectively, the difference was statistically significant (P <0.05). (2) The levels of creatine kinase (CK), creatine kinase MB (CK-MB) and myocardial infarct size (S) in the three groups were significantly lower than those in group A and group B <0 · 05). (3) There were 59 deaths and 611 cases of survival during hospitalization. The serum sodium levels in survival group and death group were (13300 ± 5.25) mmol / L and (122.00 ± 7.25) mmol / L, respectively. The difference between the two groups was statistically significant (P <0.01). (4) By multivariate logistic regression analysis, the risk factors of death during hospitalization 30 days after AMI were analyzed. The decrease of serum sodium ion concentration was related to the hospitalization mortality rate 30 days after AMI. And the mortality rate during the 30-day hospitalization increased with the decrease of serum sodium concentration. Conclusions Hyponatremia may be one of the markers of poor prognosis in AMI.