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失代偿期肝硬化患者低钠血症与肝损伤程度及并发症的关系
Association of hyponatremia with degree of liver injury and complications in patients with decompensated liver cirrhosis
文章发布日期:2017年01月06日  来源:  作者:武健,尹芳,罗贯虹,等  点击次数:1814次  下载次数:380次

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【摘要】:目的分析失代偿期肝硬化患者低钠血症与肝损伤程度及并发症发生情况的相关性。方法选取2015年7月-2016年7月第四军医大学西京医院消化内科收治的142例失代偿期肝硬化合并低钠血症患者进行回顾性分析。根据入院时血钠浓度将所选患者分为轻度、中度、重度3组。比较不同分组的Child-Pugh评分、终末期肝病模型(MELD)评分及主要并发症的发生情况。所有患者均随访3个月,研究并记录随访时出现腹水、自发性腹膜炎、肝性脑病等并发症及病死率与低钠血症的相关性。计量资料组间比较采用χ2检验,相关性分析采用Spearman分析。 结果轻度低钠组Child-Pugh A级患者比例较高(42.3%),重度低钠组Child-Pugh C级患者比例较高(72.4%),3组患者的Child-Pugh评分差异有统计学意义(χ2=50.175,P=0000 2);血钠水平随Child-Pugh评分的上升而降低,差异有统计学意义(r=-0.464,P=0002 3)。 轻度低钠组MELD评分≤9患者比例较高(507%),重度低钠组MELD评分≥30患者比例较高(62.1%),3组患者的肝功能MELD评分的分布差异有统计学意义(χ2=75106,P=0000 8)。血钠水平随MELD评分的上升而降低,差异有统计学意义(r=-0.644,P=0004 5)。轻度、中度、重度低钠血症的腹水发生率为71.8%、92.9%、100.0%;自发性腹膜炎为14.1%、31.0%、65.5%;肝性脑病发生率分别为14.1%、35.7%、552%;病死率分别为12.7%、33.3%、65.5%。3组的并发症发生率和病死率比较,差异均有统计学意义(χ2值分别为14.127、24467,P值均<0.05)。结论血钠可作为一个预测指标判定失代偿期肝硬化患者并发症的发生率。
【Abstract】:ObjectiveTo investigate the association of hyponatremia with the degree of liver injury and complications in patients with decompensated liver cirrhosis. MethodsA retrospective analysis was performed for the clinical data of 142 patients with decompensated liver cirrhosis complicated by hyponatremia who were admitted to Department of Gastroenterology, Xijing Hospital of Fourth Military Medical University from July 2015 to July 2016. The patients were divided into mild group, moderate group, and severe group according to serum sodium concentration on admission. The Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, and major complications were compared between groups. All the patients were followed up for 3 months, and the complications such as ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy were recorded. The association of hyponatremia with complications and mortality was investigated. The chi-square test was used for comparison of categorical data between groups, and the Spearman corretation analysis was also performed. ResultsThe mild group had a high proportion of Child-Pugh class A patients (42.3%) and the severe group had a high proportion of Child-Pugh class C patients (72.4%). There was a significant difference in Child-Pugh score between the mild, moderate, and severe groups (χ2=50.175, P=0.000 2). The serum sodium level decreased with the increasing Child-Pugh score (r=-0.464, P=0.002 3). The mild group had a high proportion of patients with an MELD score of ≤9 (50.7%) and the severe group had a high proportion of patients with an MELD score of ≥30 (62.1%). There was a significant difference in the distribution of MELD scores between the mild, moderate, and severe groups (χ2=75.106, P=0.000 8). The serum sodium level decreased with the increasing MELD score (r=-0.644, P=0004 5). The incidence rates of ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy were 71.8%/92.9%/100.0%, 141%/31.0%/65.5%, and 14.1%/35.7%/55.2%, respectively, in the mild, moderate, and severe groups. The mortality rate was 12.7%, 33.3%, and 65.5% in these three groups, respectively. There were significant differences in the incidence rate of complications and mortality rate between the three groups (χ2=14.127 and 24.467, both P<0.05). ConclusionSerum sodium level can be used as a predictor for the incidence rate of complications in patients with decompensated liver cirrhosis.
【关键字】:肝硬化; 低钠血症; 腹水; 腹膜炎; 肝性脑病
【Key words】:liver cirrhosis; hyponatremia; ascites; peritonitis; hepatic encephalopathy
【引证本文】:武健, 尹芳, 罗贯虹, 等. 失代偿期肝硬化患者低钠血症与肝损伤程度及并发症的关系[J]. 临床肝胆病杂志, 2017, 33(2): 277-280.

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