CAJ | 학술논문

目的：探讨急性失代偿性心衰患者血钠水平、肺动脉收缩压的变化及其与肾小球滤过率的关系。方法选取急性失代偿性心力衰竭住院患者120例，入院当天测定血清钠、血清肌酐与血清 N 末端 B 型利钠肽原（NT －proBNP）水平，选用改良 MDRD 方程计算肾小球滤过率估算值（eGFR）。入院48 h 内行心脏彩色超声检查测得肺动脉收缩压、左室射血分数值。根据血清钠水平将全部入选病例分为低钠血症组（血清钠＜135 mmol／L，n ＝41）与血钠正常组（血清钠≥135 mmol／L，n ＝79），对比两组的肺动脉收缩压、eGFR、NT －proBNP 以及左室射血分数。在低钠血症组中研究血清钠与肺动脉收缩压、eGFR、NT －proBNP 及肺动脉收缩压与 eGFR、NT －proBNP 的相关性。结果低钠血症组与正常血钠组相比，肺动脉收缩压、NT －proBNP 值偏高（P ＜0．05），而 eGFR 偏低（P ＜0．05），左室射血分数较低，但差异无统计学意义（P ＞0．05）。血清钠与肺动脉收缩压、NT －proBNP 的自然对数值均呈负相关（r ＝－0．620，P ＜0．05；r ＝－0．494，P ＜0．05），与 eGFR 值呈正相关（r ＝0．816，P ＜0．05）；肺动脉收缩压与 eGFR 值呈负相关（r ＝－0．558，P ＜0．05），与 NT －proBNP 的自然对数值呈正相关（r ＝0．830，P ＜0．05）；左室射血分数与血清钠、肺动脉收缩压均无关（P ＞0．05）。结论急性失代偿性心力衰竭患者中低钠血症及肺动脉收缩压升高与肾小球滤过率降低密切相关，可能作为预测心肾综合征高危人群的实用指标。
목적：탐토급성실대상성심쇠환자혈납수평、폐동맥수축압적변화급기여신소구려과솔적관계。방법선취급성실대상성심력쇠갈주원환자120례，입원당천측정혈청납、혈청기항여혈청 N 말단 B 형리납태원（NT －proBNP）수평，선용개량 MDRD 방정계산신소구려과솔고산치（eGFR）。입원48 h 내행심장채색초성검사측득폐동맥수축압、좌실사혈분수치。근거혈청납수평장전부입선병례분위저납혈증조（혈청납＜135 mmol／L，n ＝41）여혈납정상조（혈청납≥135 mmol／L，n ＝79），대비량조적폐동맥수축압、eGFR、NT －proBNP 이급좌실사혈분수。재저납혈증조중연구혈청납여폐동맥수축압、eGFR、NT －proBNP 급폐동맥수축압여 eGFR、NT －proBNP 적상관성。결과저납혈증조여정상혈납조상비，폐동맥수축압、NT －proBNP 치편고（P ＜0．05），이 eGFR 편저（P ＜0．05），좌실사혈분수교저，단차이무통계학의의（P ＞0．05）。혈청납여폐동맥수축압、NT －proBNP 적자연대수치균정부상관（r ＝－0．620，P ＜0．05；r ＝－0．494，P ＜0．05），여 eGFR 치정정상관（r ＝0．816，P ＜0．05）；폐동맥수축압여 eGFR 치정부상관（r ＝－0．558，P ＜0．05），여 NT －proBNP 적자연대수치정정상관（r ＝0．830，P ＜0．05）；좌실사혈분수여혈청납、폐동맥수축압균무관（P ＞0．05）。결론급성실대상성심력쇠갈환자중저납혈증급폐동맥수축압승고여신소구려과솔강저밀절상관，가능작위예측심신종합정고위인군적실용지표。
Objective To investigate the change of serum sodium level and pulmonary arterial systolic pressure(PASP),and their relevance with glomerular filtration rate(GFR)in patients with acute decompensated heart failure(ADHF).Methods A total of 120 patients with ADHF were enrolled in this study.The datas of serum sodium,creatinin and NT -proBNP were detec-ted in the first day of hospitalization,then eGFR was obtained by the modified MDRD equation.The value of PASP and left ven-tricular ejection fraction(LVEF)were measured by the color doppler ultrasound equipment.All the patients were divided into hy-ponatremia group and non -hyponatremia group according to the serum sodium level(serum sodium <135 mmol/L was defined as hyponatremia,n =41;serum sodium≥135mmol/L was defined as non -hyponatremia,n =79).The levels of PASP,NT -proB-NP,eGFR and LVEF were compared between the two groups.The relevance between serum sodium and PASP,eGFR,NT -proBNP,LVEF were respectively analyzed in hyponatremia group.The relevance between PASP and eGFR,NT -proBNP, LVEF was also respectively analyzed in hyponatremia group.Results The levels of PASP and NT -proBNP in hyponatremia group were higher than non -hyponatremia group(P <0.05),while eGFR was lower(P <0.05)and LVEF was lower without statistical significance(P >0.05).Serum sodium was negatively correlated with PASP and the natural logarithm of NT -proBNP (r =-0.620,P <0.05;r =-0.494,P <0.05).Serum sodium was positively correlated with eGFR(r =0.816,P <0.05). PASP was significantly negatively correlated with eGFR(r =-0.558,P <0.05)and positively correlated with the natural log-arithm of NT -proBNP(r =0.830,P <0.05).Neither serum sodium or PASP was correlated with LVEF (P >0.05).Conclu-sion Both hyponatremia and the increase of PASP are correlated with the decrease of eGFR in patients with ADHF,and they may be useful for predicting cardiorenal syndrome.