低钠血症的发生率及其对肝硬化相关并发症的影响。

Frequency of hyponatraemia and its influence on liver cirrhosis-related complications.

作者信息

Shaikh Samiullah, Mal Gomo, Khalid Shaikh, Baloch Ghulam Hussain, Akbar Yousfani

机构信息

Department of Medicine, Liaquat University of Medical & Health Sciences, Jamshoro, Hyderabad.

出版信息

J Pak Med Assoc. 2010 Feb;60(2):116-20.

PMID:20209698

Abstract

OBJECTIVE

To evaluate the frequency, clinical associations and prognostic impact of hyponatraemia on cirrhosis related complications in patients with cirrhosis of liver.

METHODS

In this case control study 217 cirrhotic patients consecutively admitted to our department from September 2006 to November 2007 were studied. Serum sodium levels were determined in all patients admitted. The cutoff level of 130 meq/l was chosen because it is widely accepted to define hyponatraemia in patients with cirrhosis while the level of 135 meq/L is the lower normal value. Patients were grouped on the basis of serum sodium concentration into (1) serum sodium <130 meq/L (Group 1) (2) serum sodium between 131 - 135 meq/l (Group 2), and (3) serum sodium >135 meq/l (Group 3). P values of less than 0.05 were considered as significant. The patients with hyponatraemia Group 1 (<130 meq/l) and group 2 (131-135 meq/l) were compared with group 3 (>135 meq/l) for the severity of liver disease, degree of ascites and other cirrhosis related complications such as hepatorenal syndrome, spontaneous bacterial peritonitis and hepatic encephalopathy.

RESULTS

This case control study constituted 217 consecutive cirrhotic patients of which 141 (65%) were male and 76/217 (35%) were female. Hyponatraemia (sodium <130 meq/l) was found in 58/217 (26.7%) patients and 54/217 (24.9%) had serum sodium from 131-135 meq/l whereas 105/217 (48.4%) patients had serum sodium >135. Out of 58 patients with hyponatraemia, 48 were in Child-Pugh C class (p=0.001). Patients with serum sodium <130 meq/l had more severe ascites (p = 0.001) requiring frequent paracentesis and higher dosages of diuretics. Hepatic encephalopathy was more frequent in patients with serum sodium <130 meq/l (p= 0.001). The cirrhosis related complications were also significantly increased in patients with mild hyponatraemia (131-135 meq/l) than in patients with normal serum sodium (>135 meq/l).

CONCLUSION

Hyponatraemia is frequent in cirrhotic patients. It is seldom spontaneous and has a negative influence on cirrhosis related complications.

摘要

目的

评估低钠血症在肝硬化患者中出现的频率、临床关联以及对肝硬化相关并发症的预后影响。

方法

在这项病例对照研究中，对2006年9月至2007年11月连续入住我科的217例肝硬化患者进行了研究。测定了所有入院患者的血清钠水平。选择130毫当量/升作为临界值，因为在肝硬化患者中这一数值被广泛认可用于定义低钠血症，而135毫当量/升是正常下限值。根据血清钠浓度将患者分为三组：（1）血清钠<130毫当量/升（第1组）；（2）血清钠在131 - 135毫当量/升之间（第2组）；（3）血清钠>135毫当量/升（第3组）。P值小于0.05被认为具有统计学意义。将低钠血症组（第1组，<130毫当量/升）和第2组（131 - 135毫当量/升）患者与第3组（>135毫当量/升）患者在肝病严重程度、腹水程度以及其他肝硬化相关并发症（如肝肾综合征、自发性细菌性腹膜炎和肝性脑病）方面进行比较。

结果

这项病例对照研究包括217例连续的肝硬化患者，其中141例（65%）为男性，76/217例（35%）为女性。58/217例（26.7%）患者存在低钠血症（血清钠<130毫当量/升），54/217例（24.9%）患者血清钠在131 - 135毫当量/升之间，而105/217例（48.4%）患者血清钠>135毫当量/升。在58例低钠血症患者中，48例处于Child-Pugh C级（p = 0.001）。血清钠<130毫当量/升的患者腹水更严重（p = 0.001），需要频繁进行腹腔穿刺放液并使用更高剂量的利尿剂。血清钠<130毫当量/升的患者肝性脑病更为常见（p = 0.001）。轻度低钠血症（131 - 135毫当量/升）患者的肝硬化相关并发症也比血清钠正常（>135毫当量/升）的患者显著增加。