摘要
目的探讨急性心力衰竭(AHF)患者血清氯离子(Cl^(-))水平变化及其与预后的关系。方法纳入2020年9月至2023年3月该院收治的AHF患者289例作为研究对象。收集患者临床资料、实验室资料,并检测患者入院时、出院时血清Cl^(-)水平,计算Cl^(-)水平变化差值(ΔCl^(-))。AHF患者根据随访期间不良心血管事件发生情况分为预后不良组和预后良好组,比较两组临床资料、实验室资料。多因素分析采用Logistic回归分析,以及利用rms包中的函数绘制限制性立方样条(RCS)曲线,分析血清ΔCl^(-)水平与AHF不良预后之间的关系。绘制受试者工作特征(ROC)曲线,分析ΔCl^(-)水平在预测AHF患者出院1年内不良心血管事件发生风险方面的价值。结果预后不良组年龄、合并房颤占比均高于预后良好组,差异有统计学意义(P<0.05)。预后不良组左心室射血分数(LVEF)、出院时Cl^(-)水平均低于预后良好组,预后不良组脑利钠肽(BNP)和ΔCl^(-)水平均高于预后良好组,差异有统计学意义(P<0.05)。Logistic回归分析显示,LVEF是AHF预后不良的独立保护因素,年龄、BNP和ΔCl^(-)水平是AHF预后不良的独立危险因素(P<0.05)。RCS曲线分析结果表明,ΔCl^(-)水平与AHF患者在出院后1年内不良心血管事件的发生风险之间存在显著的线性关系。ROC曲线分析结果显示,ΔCl^(-)水平在预测AHF患者出院1年内不良心血管事件发生风险方面的曲线下面积为0.857,灵敏度为88.37%,特异度为69.46%。结论AHF患者血清Cl^(-)水平变化与AHF患者预后有关,通过监测AHF患者血清Cl^(-)水平可以指导其临床早期干预。
Objective To explore the change of serum chloride ion(Cl^(-))level and its relationship with prognosis in patients with acute heart failure(AHF).Methods A total of 289 patients with AHF admitted to the hospital from September 2020 to March 2023 were included in the study.Clinical and laboratory data of patients were collected,serum Cl^(-)levels were detected at admission and discharge,and the difference of Cl^(-)levels was calculated(ΔCl^(-)).Patients with AHF were divided into poor prognosis group and good prognosis group according to the incidence of adverse cardiovascular events during follow-up.Clinical and laboratory data of the two groups were compared.Logistic regression analysis was used to analyze the relationship between serumΔCl^(-)level and poor prognosis of AHF by using restricted cubic spline(RCS)curve drawn by the functions in the rms package.Receiver operating characteristic(ROC)curve was plotted to analyze the value ofΔCl^(-)levels in predicting the risk of adverse cardiovascular events within 1 year of discharge from hospital in patients with AHF.Results The age and the proportion of patients with atrial fibrillation in the poor prognosis group were higher than those in the good prognosis group,and the difference was statistically significant(P<0.05).The levels of left ventricular ejection fraction(LVEF)and Cl^(-)at discharge in the poor prognosis group were lower than those in the good prognosis group,and the levels of brain natriuretic peptide(BNP)andΔCl^(-)in the poor prognosis group were higher than those in the good prognosis group,with statistical significance(P<0.05).Logistic regression analysis showed that LVEF was an independent protective factor for poor prognosis of AHF,and age,BNP andΔCl^(-)levels were independent risk factors for poor prognosis of AHF(P<0.05).RCS curve analysis showed a significant linear association betweenΔCl^(-)levels and the risk of adverse cardiovascular events in patients with AHF within 1 year of discharge.ROC curve analysis showed that the area under the curve ofΔCl^(-)level in predicting the risk of adverse cardiovascular events in AHF patients within 1 year after discharge was 0.857,the sensitivity was 88.37%,and the specificity was 69.46%.Conclusion The change of serum Cl^(-)level of patients with AHF is related to the prognosis of patients with AHF,and monitoring the serum Cl^(-)level of patients with AHF can guide the early clinical intervention.
作者
符丹
黄翠
余方方
李定富
FU Dan;HUANG Cui;YU Fangfang;LI Dingfu(Department of Clinical Laboratory,Hainan Western Central Hospital,Danzhou,Hainan 571700,China;Department of Cardiology,Hainan Western Central Hospital,Danzhou,Hainan 571700,China)
出处
《国际检验医学杂志》
2025年第13期1591-1596,共6页
International Journal of Laboratory Medicine
基金
海南省卫生健康行业科研项目(20A200353)。
关键词
急性心力衰竭
氯离子
预后
acute heart failure
chloride ion
prognosis
