Ginès Pere, Cárdenas Andrés
Liver Unit, Hospital Clínic and University of Barcelona, Institut d'Investigacions Biomèdiques August Pi-Sunyer, Ciber de Enfermedades Hepaticas y Digestivas, Barcelona, Spain.
Semin Liver Dis. 2008 Feb;28(1):43-58. doi: 10.1055/s-2008-1040320.
Ascites is the most common complication of cirrhosis and is associated with an increased risk for the development of infections, dilutional hyponatremia, renal failure, and mortality. Cirrhotic patients who develop ascites and associated complications have a low probability of long-term survival without liver transplantation, and therefore should be referred for evaluation of liver transplantation. While the initial management of uncomplicated ascites with low-sodium diet and diuretic treatment is straightforward in the majority of patients, there is a group of patients who fail to respond to diuretics and develop refractory ascites. The development of specific associated complications such as dilutional hyponatremia may further challenge the management of patients with ascites. New pharmacological agents such as the V2 receptor antagonists, drugs that directly antagonize the effects of elevated plasma antidiuretic hormone levels, induce solute-free water diuresis and seem to be promising in the management of patients with cirrhosis, ascites, and dilutional hyponatremia. This article focuses on the pathophysiology, clinical consequences, current management, and new treatment modalities for ascites and dilutional hyponatremia in cirrhosis.
腹水是肝硬化最常见的并发症，与感染、稀释性低钠血症、肾衰竭及死亡风险增加相关。发生腹水及相关并发症的肝硬化患者，若不进行肝移植，长期存活的概率很低，因此应转诊接受肝移植评估。虽然多数患者通过低钠饮食和利尿剂治疗对单纯性腹水进行初始管理很简单，但有一组患者对利尿剂无反应并发展为难治性腹水。诸如稀释性低钠血症等特定相关并发症的发生可能会进一步挑战腹水患者的管理。新型药理学药物如V2受体拮抗剂，即直接拮抗血浆抗利尿激素水平升高作用的药物，可诱导无溶质水利尿，在肝硬化、腹水及稀释性低钠血症患者的管理中似乎很有前景。本文重点关注肝硬化腹水及稀释性低钠血症的病理生理学、临床后果、当前管理及新的治疗方式。
