摘要
目的探讨住院患者低钠血症的患病率及相关病因,低钠血症对死亡的影响。方法回顾性分析2014年1—4月在浙江大学舟山医院住院的525例年龄≥14岁的低钠血症患者,按照低血钠程度分为轻、中、重度低钠血症组,分析各组的常见病因,并应用logistic回归模型分析低钠血症对患者死亡的影响。结果(1)该时段全院≥14岁住院患者9989例,低钠血症患者525例,患病率5.26%,老年患者(≥60岁)患病率为6.1%(264/4334)。(2)恶性肿瘤、感染性疾病在各组中均多见,脑出血在中、重度组多见。恶性肿瘤中肺癌最多,感染性疾病中肺炎最多;中、重度组脑出血中颅脑外伤致蛛网膜下腔出血最多。老年患者以恶性肿瘤、感染性疾病比例最高。(3)低钠血症中抗利尿激素分泌不当综合征(syndrome of inappropriate antidiuretic hormone secretion,SIADH)和脑耗盐综合征(cerebral salt-wasting syndrome,CSWS)的比例分别为13.7%和3.8%,老年患者中SIADH和CSWS的比例分别为17.4%和4.2%。(4)中、重度组排钠药物使用比例较轻度组更高(42.2%比21.4%,43.2%比21.4%,P值均<0.05)。(5)Logistic回归分析显示,中度组死亡风险是轻度组的6.92倍(95%CI 2.53~18.92,P<0.001),重度组死亡风险是轻度组的4.54倍(95%CI 1.05~19.58,P=0.043),而重度与中度组死亡风险差异无统计学意义。结论低钠血症是住院患者常见的电解质紊乱,主要的原发病因为恶性肿瘤(肺癌)、感染性疾病(肺炎)和脑出血,伴发SIADH和CSWS是上述疾病导致低钠血症的重要原因,排钠药物的使用更易发生中重度低钠血症。与轻度组比较,中、重度低钠血症增加住院患者死亡风险。
Objective The study was aimed to investigate the prevalence and causes of hyponatremia in hospitalized patients,and to analyze the relationship between hyponatremia and mortality.Methods A retrospective analysis was carried out in 525 patients with hyponatremia,who were older than 14 years old and hospitalized in the Zhoushan Hospital from Jan.2014 to Apr.2014.Based on the severity of the hyponatremia the patients were divided into three groups:the mild,moderate and severe hyponatremia groups.The underlying causes of hyponatremia were analyzed,and the association between hyponatremia and mortality was explored using logistic regression analyses.Results(1)The prevalence of hyponatremia was 5.26%in whole hospitalized patients(n=9989)during the study period.It was 6.1%in the elderly population(≥60 years old).(2)Malignant tumors and infectious diseases were the main primary diseases of hyponatremia in all three groups.Among them,lung cancer was the most common malignant tumor,and pneumonia was the most common infectious disease associated with hyponatremia.Cerebral hemorrhage was common in patients with moderate and severe hyponatremia,in which subarachnoid hemorrhage was the major primary disease associated with moderate to severe hyponatremia.In the subgroup of elderly patients,malignant tumor and infectious diseases were the major basic diseases.(3)Among the 525 cases,13.7%and 3.8%of them were diagnosed with syndrome of inappropriate antidiuretic hormone secretion(SIADH)and cerebral salt-wasting syndrome(CSWS),respectively.The proportions of SIADH and CSWS increased to 17.4%and 4.2%,respectively,in the elderly hyponatremic patients(n=264).(4)More patients were prescribed with sodium-excretion drugs in the moderate and severe hyponatremia groups than those in the mild one(42.2%vs.21.4%,43.2%vs.21.4%,all P<0.05).(5)Patients with moderate or severe hyponatremia had a higher mortality compared to those with mild hyponatremia(moderate vs.mild group:OR 6.92,95%CI 2.53-18.92,P<0.001;severe vs.mild group:OR 4.54,95%CI 1.05-19.58,P=0.043).Conclusions Hyponatremia was common in hospitalized patients.The major primary diseases were malignant tumor(lung cancer),infectious diseases(pneumonia)and cerebral hemorrhage complicated with SIADH and CSWS.Use of sodium-excretion drugs increased the risk of moderate to severe hyponatremia.Patients with moderate to severe hyponatremia had a higher risk of death in hospitals.
作者
郑焱
郑芬萍
李红
Zheng Yan;Zheng Fenping;Li Hong(Department of Endocrinology,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310016,China;Department of Endocrinology,Zhoushan Hospital,Zhejiang University,Zhoushan 316000,China)
出处
《中华内科杂志》
CAS
CSCD
北大核心
2020年第1期29-34,共6页
Chinese Journal of Internal Medicine
作者简介
通信作者:李红,Email:srrshnfm@zju.edu.cn。
