低钠血症对失代偿期肝硬化患者肝损伤程度及预后的影响

李影; 徐吉哲; 梁丽娜; 刘丽娜

doi:10.3969/j.issn.1001-5256.2016.03.021

低钠血症对失代偿期肝硬化患者肝损伤程度及预后的影响

DOI: 10.3969/j.issn.1001-5256.2016.03.021

大连医科大学附属第一医院消化内科

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中图分类号: R575.2
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- 出版日期: 2016-03-20

Relationship of hyponatremia with degree of liver injury and prognosis in patients with decompensated liver cirrhosis

Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University

摘要

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、并发症及生存期的关系,探讨低钠血症对失代偿期肝硬化患者预后的评估作用。方法收集2000年1月-2005年3月于大连医科大学附属第一医院住院的首次确诊为失代偿期肝硬化的患者218例,根据血钠浓度分为3组,血钠浓度≥130 mmol/L为Ⅰ组（n=51）,120 mmol/L≤血钠浓度<130 mmol/L为Ⅱ组（n=97）,血钠浓度<120 mmol/L为Ⅲ组（n=70）。对患者的性别、年龄、血钠浓度、Child-Pugh分级及并发症等进行回顾性分析,并计算生存时间。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;计数资料组间比较采用χ2检验;以KaplanMeier方法进行生存时间分析,回归分析采用Cox回归模型。结果与Ⅰ、Ⅱ组比较,Ⅲ组中Child-Pugh C级患者比例最高;血钠浓度随着Child-Pugh评分增加而降低,Child-Pugh A、B、C级三者患者的血钠浓度比较差异有统计学意义（F=17.336,P<0.001）,进一步两两比较差异均有统计学意义（P值均<0.05）;与Ⅰ...
- 肝硬化 /
- 低钠血症 /
- 预后
Abstract: Objective To investigate the relationship between hyponatremia and degree of liver injury,complications and survival time,and the prognostic value of hyponatremia in patients with decompensated liver cirrhosis. Methods A total of 218 patients who were diagnosed with decompensated liver cirrhosis for the first time in The First Affiliated Hospital of Dalian Medical University from January 2000 to March2005 were enrolled in this study,and according to the serum sodium concentration,these patients were divided into group Ⅰ with a serum sodium concentration of ≥130 mmol / L( n = 51),group Ⅱ with a serum sodium concentration of ≥120 and < 130 mmol / L( n = 97),group Ⅲ with a serum sodium concentration of < 120 mmol / L( n = 70). The patients' sex,age,serum sodium concentration,Child- Pugh class,and complications were analyzed,and the survival time was calculated. The one- way analysis of variance was applied for comparison of continuous data between groups,and the least significant difference t- test was applied for comparison between any two patients; the chi- square test was applied for comparison of categorical data between groups; the Kaplan- Meier method was applied for survival analysis,and the Cox regression model was applied for regression analysis. Results Compared with groups Ⅰ and Ⅱ,group Ⅲ had the highest proportion of patients with Child- Pugh C cirrhosis. With the increasing Child- Pugh score,the serum sodium concentration decreased; the serum sodium concentration showed significant differences across the patients with Child- Pugh A,B,and C cirrhosis( F = 17. 336,P <0. 001),and differed significantly between any two groups of these patients( all P < 0. 05). Compared with groups Ⅰ and Ⅱ,group Ⅲ had the highest incidence rate of complications,and the incidence rates of hepatic encephalopathy and hepatorenal syndrome showed significant differences across the three groups( χ2= 17. 718 and 6. 277,both P < 0. 05). Group Ⅲ had a significantly shorter survival time than groupsⅠ and Ⅱ( both P < 0. 05). Conclusion In patients with decompensated liver cirrhosis,the severity and incidence rate of hyponatremia increase significantly as liver injury becomes more severe,which suggests that hyponatremia can be used as a prognostic indicator in patients with decompensated liver cirrhosis.
- liver cirrhosis /
- hyponatremia /
- prognosis

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参考文献(16)

[1]SOLE,WATSON H,GRAUPERA I,et al.Factors related to quality of life in patients with cirrhosis and ascites:relevance of serum sodium concentration and leg edema[J].J Hepatol,2012,57(6):1199-1206.

[2]LIU HL.Relationship ketween hyponatremia and main compli-cations in patients with decompensated cirrhosis[J].J Clin Exp Med,2015,14(17):1448-1450.(in Chinese)刘红凌.肝硬化失代偿期患者低钠血症与其他并发症相关性研究[J].临床和实验医学杂志,2015,14(17):1448-1450.

[3]GE JB,XU YJ.Internal medicine[M].8th ed.Beijing:People’s Health Publishing House,2013:424-425.(in Chinese)葛均波,徐永健.内科学[M].第八版.北京:人民卫生出版社,2013:424-425.

[4]SHAW BW,WOOD RP,STRATTA RJ,et al.Stratifying the causes of death in liver transplant recipients:an approach to improving survival[J].Arch Surg,1989,124(8):895-900.

[5]KIM WR,THERNEAU TM,WIESNER RH,et al.A revised natural history model for primary sclerosing cholangitis[J].Mayo Clin Proc,2000,75(7):688-694.

[6]KAMATH PS,WIESNER RH,MALINCHOC M,et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology,2001,33(2):464-470.

[7]QIAN LX,WANG BE.Prognostic factors and high-risk factors for liver cirrhosis[J].Chin J Intern Med,1995,34(5):338-339.(in Chinese)钱林学,王宝恩.肝硬化预后因素和预后高危因素的研究[J].中华内科杂志,1995,34(5):338-339.

[8]ANGELI P,WONG F,WATSON H,et al.Hyponatremia in cirrhosis:results of a patient population survey[J].Hepatology,2006,44(6):1535-1542.

[9]GINS P,CRDENAS A,SCHRIER RW.Liver disease and the kidney[M]//Schrier RW.Diseases of the kidney and urinary tract.8th ed.Philadelphia:Lippincott Williams&Wilkins,2007:2179-2205.

[10]CHEN QJ.Hyponatremia in patients with liver cirrhosis:a clinical analysis[J].Chin Med Mod Dist Educ China,2008,6(1):49.(in Chinese)陈欣菊.肝硬化病人低钠血症的临床分析[J].中国中医药现代远程教育,2008,6(1):49.

[11]QURESHI MO,KHOKHAR N,SALEEM A,et al.Correlation of hyponatremia with hepatic encephalopathy and severity of liver disease[J].J Coll Physicians Surg Pak,2014,24(2):135-137.

[12]PHAM PT,PHAM PC,RASTOGI A,et al.Review article:current management of renal dysfunction in the cirrhotic patient[J].Aliment Pharmacol Ther,2005,21(8):949-961.

[13]KIM JH,LEE JS,LEE SH,et al.The association between the serum sodium level and the severity of complications in liver cirrhosis[J].Korean J Intern Med,2009,24(2):106-112.

[14]PLANAS R,MONTOLIU S,BALLESTB,et al.Natural history of patients hospitalized for management of cirrhotic ascites[J].Clin Gastroenterol Hepatol,2006,4(11):1385-1394.

[15]HEUMAN DM,ABOU-ASSI SG,HABIB A,et al.Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death[J].Hepatology,2004,40(4):802-810.

[16]BIGGINS SW,RODRIGUEZ HJ,BACCHETTI P,et al.Serum sodium predicts mortality in patients listed for liver transplantation[J].Hepatology,2005,41(1):32-39.

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