Song Eun Kyeung, Moser Debra K, Dunbar Sandra B, Pressler Susan J, Lennie Terry A
Department of Nursing, College of Medicine, University of Ulsan, Republic of Korea
College of Nursing, University of Kentucky, USA.
Eur J Cardiovasc Nurs. 2014 Dec;13(6):541-8. doi: 10.1177/1474515113517574. Epub 2013 Dec 23.
Despite a growing recognition that a strict low sodium diet may not be warranted in compensated heart failure (HF) patients, the link between sodium restriction below 2 g/day and health outcomes is unknown in patients at different levels of HF severity.
The purpose of this study was to compare differences in event-free survival among patients with <2 g/day, 2-3 g/day, or >3 g/day sodium intake stratified by New York Heart Association (NYHA) class.
A total of 244 patients with HF completed a four-day food diary to measure daily sodium intake. All-cause hospitalization or death for a median of 365 follow-up days and covariates on age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, the presence of ankle edema, and prescribed medications were determined by patient interview and medical record review. Hierarchical Cox hazard regression was used to address the purpose.
In NYHA class I/II (n=134), patients with <2 g/day sodium intake had a 3.7-times higher risk (p=0.025), while patients with >3 g/day sodium intake had a 0.4-times lower risk (p=0.047) for hospitalization or death than those with 2-3 g/day sodium intake after controlling for covariates. In NYHA class III/IV (n=110), >3 g/day sodium intake predicted shorter event-free survival (p=0.044), whereas there was no difference in survival curves between patients with <2 g/day and those with 2-3 g/day sodium intake.
Sodium restriction below 2 g/day is not warranted in mild HF patients, whereas excessive sodium intake above 3 g/day may be harmful in moderate to severe HF patients.
尽管越来越多的人认识到，对于代偿性心力衰竭（HF）患者而言，可能无需严格的低钠饮食，但每日钠摄入量低于2克与不同严重程度HF患者健康结局之间的联系尚不清楚。
本研究旨在比较按纽约心脏协会（NYHA）分级分层的钠摄入量<2克/天、2 - 3克/天或>3克/天的患者无事件生存期的差异。
共有244例HF患者完成了一份为期四天的食物日记，以测量每日钠摄入量。通过患者访谈和病历审查确定全因住院或死亡情况（中位随访365天）以及年龄、性别、病因、体重指数、NYHA分级、射血分数、总合并症评分、是否存在踝关节水肿和处方药物等协变量。采用分层Cox风险回归分析来实现研究目的。
在NYHA I/II级（n = 134）患者中，在控制协变量后，钠摄入量<2克/天的患者住院或死亡风险比钠摄入量为2 - 3克/天的患者高3.7倍（p = 0.025），而钠摄入量>3克/天的患者风险低0.4倍（p = 0.047）。在NYHA III/IV级（n = 110）患者中，钠摄入量>3克/天预示无事件生存期较短（p = 0.044），而钠摄入量<2克/天的患者与钠摄入量为2 - 3克/天的患者之间的生存曲线无差异。
轻度HF患者无需将钠摄入量限制在2克/天以下，而对于中重度HF患者，每日钠摄入量超过3克可能有害。
