服用含噻嗪类利尿剂单片复方制剂发生低钾血症的高血压住院患者中重度低钾血症的影响因素

Factors associated with moderate-to-severe hypokalemia in hospitalized hypertensive patients with thiazide-containing single-pill combination-induced hypokalemia

    摘要
  • 摘要:
    目的 探究服用含噻嗪类利尿剂单片复方制剂（SPC）的低钾血症高血压住院患者发生中重度低钾血症的危险因素。
    方法 采用回顾性分析方法，收集2013年1月1日至2023年12月31日在南京医科大学附属淮安第一医院因低钾血症住院且服用含噻嗪类利尿剂SPC的原发性高血压患者资料。根据纳入患者的血钾水平将研究人群分为轻度低钾血症组（血钾水平3.0～＜3.5 mmol/L）和中重度低钾血症组（血钾水平< 3.0 mmol/L）。采用多因素logistic模型分析中重度低钾血症的影响因素，并进行亚组分析。
    结果 最终纳入研究对象261例，平均年龄（66.62±11.13）岁，女性占54.79%（143例）。轻度低钾血症组165例，中重度低钾血症组96例。中重度低钾血症组服用传统SPC比例51.04%（49/96）比34.55%（57/165），χ2=6.847，P=0.009、吸烟比例（χ2=3.977，P=0.046）、饮酒比例（χ2=4.072，P=0.044）高于轻度低钾血症组，血氯（Z=–2.707，P=0.007）、血钙（Z=–2.025，P=0.043）及血磷（Z=–3.097，P=0.002）水平低于轻度低钾血症组。多因素logistic回归分析结果显示，服用传统SPC药物（OR=1.917，95%CI：1.102～3.333，P=0.021），血氯水平（OR=0.940，95%CI：0.900～0.981，P=0.004）为中重度低钾血症的影响因素。亚组分析结果显示，年龄、性别、是否合并糖尿病、是否合并冠心病、是否吸烟、是否饮酒、估算的肾小球滤过率（eGFR）水平这些因素与服用含噻嗪类利尿剂SPC的类型交互作用无统计学意义（均P交互＞0.05）。
    结论 在服用含噻嗪类利尿剂SPC发生低钾血症的高血压住院患者中，服用传统SPC和血氯水平是中重度低钾血症的影响因素。

     

    Abstract:
    Objective To explore the risk-factors for moderate to severe hypokalemia in hospitalized hypertensive patients with hypokalemia who are taking single-pill combination (SPC) containing thiazide diuretics.
    Methods A retrospective analysis was conducted. Data were collected from patients with essential hypertension who were hospitalized for hypokalemia at Huai'an First People's Hospital, Nanjing Medical University, between January 1, 2013, and December 31, 2023, and who were taking thiazide-containing SPC. Based on serum potassium levels, the subjects were divided into a mild hypokalemia group (serum potassium level: 3.0 to ＜3.5 mmol/L) and a moderate-to-severe hypokalemia group (serum potassium leve: < 3.0 mmol/L). Multivariate logistic model was used to analyze the factors related to moderate-to-severe hypokalemia.
    Results A total of 261 subjects were included, with a mean age of (66.62 ± 11.13) years, and 54.79% (143 cases) were female. Among them, 165 were in the mild hypokalemia group, and 96 were in the moderate-to-severe hypokalemia group. Compared with patients in the mild hypokalemia group, patients in the moderate-to-severe hypokalemia group had a significantly higher proportion of taking traditional SPC (51.04% 49/96 vs 34.55% 57/165, χ2 = 6.847, P = 0.009), smokers (χ2= 3.977, P = 0.046), and alcohol consumers (χ2= 4.072, P = 0.044). Additionally, serum chloride (Z = –2.707, P = 0.007), calcium (Z = –2.025, P = 0.043), and phosphorus (Z = –3.097, P = 0.002) levels were significantly lower in the moderate-to-severe hypokalemia group. Multivariate logistic regression analysis showed that taking traditional SPC (OR = 1.917, 95%CI: 1.102 to 3.333, P = 0.021) and serum chloride levels (OR = 0.940, 95%CI: 0.900 to 0.981, P = 0.004) were influencing factors for moderate-to-severe hypokalemia. Subgroup analysis results showed that, the interactions between factors such as age, sex, comorbid diabetes, comorbid coronary heart disease, smoking, alcohol consumption, and estimated glomerular filtration rate (eGFR) level with the type of SPC containing thiazide diuretics were not statistically significant (all P for interaction ＞ 0.05).
    Conclusion The traditional SPC and serum chloride levels are influencing factors for the moderate-to-severe hypokalemia in hospitalized hypertensive patients taking SPC containing thiazide diuretics.

     

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