De Bacquer D, De Backer G, De Buyzere M, Kornitzer M
Department of Public Health, University of Gent, Belgium.
J Cardiovasc Risk. 1998 Jun;5(3):177-84.
Serum chloride level is routinely assayed in clinical laboratories in the management of patients with kidney disorders and with metabolic diseases. It is a biological parameter that is easily, precisely and relatively cheaply measured. The epidemiological features of serum chloride levels have not been studied before.
For the random sample of men and women from the Belgian Interuniversity Research on Nutrition and Health aged 25-74 years, free of symptomatic coronary heart disease at baseline, serum chloride concentrations were measured, among those of other electrolytes. The cohort was followed up for 10 years with respect to subsequent cause-specific mortality.
The results are based on observations of 4793 men and 4313 women. According to Cox regression analysis serum chloride level was one of the strongest predictors of total, cardiovascular disease (CVD) and non-CVD mortalities independently of age, body mass index, sex, smoking, systolic blood pressure, levels of total and high-density lipoprotein cholesterol, uric acid, serum creatinine and serum total proteins and intake of diuretics. This relation was proved to be independent of levels of other serum electrolytes and similar for men and women. The estimated adjusted risk ratio for CVD death for subjects with a serum chloride level < or =100 mmol/l compared with those with levels above that limit was 1.65 (95% confidence interval 1.06-2.57) for men and 2.16 (95% confidence interval 1.11-4.22) for women. The study of adjusted risk ratios for four groups of subjects defined on the basis of their baseline serum chloride levels revealed a decreasing log-linear 'dose-response' relation to total and cardiovascular mortalities.
This s the first report from a population-based study to indicate that there is an association between serum chloride level and the incidence of total, CVD and non-CVD mortalities. The risk ratio for CVD mortality associated with a low serum chloride level was comparable to or higher than those observed for well-established CVD risk factors.
在肾脏疾病和代谢性疾病患者的管理中，临床实验室常规检测血清氯水平。它是一种易于、精确且相对廉价测量的生物学参数。血清氯水平的流行病学特征此前尚未得到研究。
对比利时大学间营养与健康研究中年龄在25 - 74岁、基线时无症状冠心病的男性和女性随机样本，在检测其他电解质的同时，测量血清氯浓度。对该队列进行了10年的随访，观察后续特定病因死亡率。
结果基于对4793名男性和4313名女性的观察。根据Cox回归分析，血清氯水平是全因死亡率、心血管疾病（CVD）和非CVD死亡率最强的预测指标之一，独立于年龄、体重指数、性别、吸烟、收缩压、总胆固醇和高密度脂蛋白胆固醇水平、尿酸、血清肌酐、血清总蛋白以及利尿剂摄入量。这种关系被证明独立于其他血清电解质水平，且男女相似。血清氯水平≤100 mmol/l的男性与高于该水平的男性相比，CVD死亡的估计调整风险比为1.65（95%置信区间1.06 - 2.57），女性为2.16（95%置信区间1.11 - 4.22）。根据基线血清氯水平定义的四组受试者调整风险比的研究显示，与全因死亡率和心血管死亡率呈对数线性“剂量反应”关系降低。
这是基于人群研究的首份报告，表明血清氯水平与全因死亡率、CVD和非CVD死亡率之间存在关联。与低血清氯水平相关的CVD死亡风险比与已确定的CVD风险因素观察到的风险比相当或更高。
