低钠饮食的依从性在心力衰竭患者的抑郁症状与预后的相互关系中起作用。
Adherence to the low-sodium diet plays a role in the interaction between depressive symptoms and prognosis in patients with heart failure.
机构信息
College of Nursing, University of Kentucky, Lexington, KY, USA.
出版信息
J Cardiovasc Nurs. 2009 Jul-Aug;24(4):299-305; quiz 306-7. doi: 10.1097/JCN.0b013e3181a6a1e5.
BACKGROUND
Although a low-sodium diet (LSD) is important in self-management of patients with heart failure (HF), the impact of LSD on event-free survival has not been investigated. Depressive symptoms predict worse event-free survival, in part, by affecting adherence to self-management. However, there are few investigations of the relationship among depressive symptoms, adherence to the LSD, and event-free survival.
PURPOSE
The purpose of this study was to determine the relationships among adherence to the LSD, depressive symptoms, and event-free survival.
METHODS
A total of 254 patients (57% male, 62 ± 14 years, 52% New York Heart Association class III/IV, ejection fraction of 36% ± 14%) were recruited from outpatient HF clinics in Korea. Twenty-four-hour urinary sodium excretion was collected as an indicator of patient adherence to the LSD. Patients were grouped based on the cut point of 3 g of urinary sodium excretion. Depressive symptoms were assessed by the Korean version of Beck Depression Inventory, and patients were split into 2 groups at the cutoff of the Korean version of Beck Depression Inventory. Event-free survival for 12 months was determined by medical records. Hierarchical Cox proportional hazards regression was used to determine the association of depressive symptoms and adherence to 3-g sodium intake on event-free survival.
RESULTS
After controlling for age, sex, etiology of HF, body mass index, New York Heart Association class, ejection fraction, N-terminal B-type natriuretic peptide, and total comorbidity score, nonadherence to 3-g sodium intake (hazard ratio = 1.56, 95% confidence interval = 1.05-2.32) and depressive symptoms (hazard ratio = 2.21, 95% confidence interval = 1.47-3.33) independently predicted event-free survival. Patients with sodium intake higher than 3 g and with depressive symptoms demonstrated a 3.7 times higher risk for cardiac events compared with patients with sodium intake lower than 3 g and without depressive symptoms (P < .001).
CONCLUSION
Improvement of adherence to the LSD and treatment for depressive symptoms could improve event-free survival.
背景
尽管低钠饮食（LSD）对于心力衰竭（HF）患者的自我管理很重要，但 LSD 对无事件生存的影响尚未得到研究。抑郁症状通过影响自我管理的依从性来预测更差的无事件生存，部分原因是这样。然而，关于抑郁症状、LSD 依从性和无事件生存之间的关系的研究很少。
目的
本研究旨在确定 LSD 依从性、抑郁症状和无事件生存之间的关系。
方法
总共招募了 254 名患者（57%为男性，62 ± 14 岁，52%为纽约心脏协会 III/IV 级，射血分数为 36% ± 14%），他们来自韩国的 HF 门诊。24 小时尿钠排泄量被收集作为患者遵守 LSD 的指标。根据 3 克尿钠排泄量的切点将患者分组。抑郁症状通过韩国版贝克抑郁量表进行评估，患者在韩国版贝克抑郁量表的截点处分为 2 组。通过医疗记录确定 12 个月的无事件生存。使用分层 Cox 比例风险回归来确定抑郁症状和 3 克钠摄入量依从性对无事件生存的关联。
结果
在控制年龄、性别、HF 病因、体重指数、纽约心脏协会分级、射血分数、N 末端 B 型利钠肽和总合并症评分后，不遵守 3 克钠摄入量（风险比=1.56，95%置信区间=1.05-2.32）和抑郁症状（风险比=2.21，95%置信区间=1.47-3.33）独立预测无事件生存。钠摄入量高于 3 克且有抑郁症状的患者与钠摄入量低于 3 克且无抑郁症状的患者相比，心脏事件的风险增加了 3.7 倍（P <.001）。
结论
改善 LSD 的依从性和治疗抑郁症状可以提高无事件生存率。
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