Park Jae Eun, Lee Chang Hyeong, Kim Byung Seok, Shin Im Hee
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Korean J Hepatol. 2010 Mar;16(1):66-74. doi: 10.3350/kjhep.2010.16.1.66.
BACKGROUND/AIMS: Twenty-four hour urinary sodium excretion (24-h UNa) of greater than 78 mmol/day is important in the management of cirrhotic ascites. Although the random urine sodium-to-potassium ratio (UNa/K) is strongly correlated with 24-h UNa, and approximately 95% of patients with a random UNa/K greater than 1 have 24-h UNa greater than 78 mmol, few data have been published on the correlation between 24-h UNa and random UNa/K. We evaluated diagnostic value of morning and afternoon random UNa/K (AM UNa/K and PM UNa/K, respectively) with 24-h UNa.
A total of 42 male patients were enrolled from October 2007 to March 2008. Each patient collected 5 mL of urine twice at random times during 24-h urine collection (at 10-12 a.m. and 3-5 p.m.). ROC curve analysis was performed to evaluate the feasibility of AM and PM UNa/K for differentiating 24-h UNa greater than 78 mmol/day.
Forty patients with a 24-h urinary creatinine of greater than 15 mg/kg were analyzed. The 24-h UNa, AM UNa/K, and PM UNa/K were 107.9+/-91.2 mmol (mean+/-SD), 3.44+/-3.64, and 3.97+/-4.60, respectively. When compared with 24-h UNa greater than 78 mmol, AUROC values for AM and PM UNa/K were 0.861 (95% CI, 0.715-0.950) and 0.929 (95% CI, 0.802-0.986), respectively (P=0.0001). No difference was found between the AUROC for AM and PM UNa/K (95% CI, -0.161-0.153, P=0.113). UNa/K greater than 1.25 was sensitive and specific for prediction of 24-h UNa greater than 78 mmol.
The results suggest that anytime random UNa/K greater than 1.25 is an accurate, cost-effective, and convenient method for replacing 24-h UNa. Large multicentered cohort studies are needed to confirm our results.
背景/目的：肝硬化腹水管理中，24小时尿钠排泄量（24-h UNa）大于78 mmol/天很重要。尽管随机尿钠钾比（UNa/K）与24-h UNa密切相关，且随机UNa/K大于1的患者中约95%的24-h UNa大于78 mmol，但关于24-h UNa与随机UNa/K之间相关性的报道较少。我们评估了晨尿和下午随机尿钠钾比（分别为AM UNa/K和PM UNa/K）与24-h UNa的诊断价值。
2007年10月至2008年3月共纳入42例男性患者。每位患者在24小时尿液收集期间随机两次收集5 mL尿液（上午10 - 12点和下午3 - 5点）。进行ROC曲线分析以评估AM和PM UNa/K区分24-h UNa大于78 mmol/天的可行性。
分析了40例24小时尿肌酐大于15 mg/kg的患者。24-h UNa、AM UNa/K和PM UNa/K分别为107.9±91.2 mmol（均值±标准差）、3.44±3.64和3.97±4.60。与24-h UNa大于78 mmol相比，AM和PM UNa/K的曲线下面积（AUROC）值分别为0.861（95%可信区间，0.715 - 0.950）和0.929（95%可信区间，0.802 - 0.986）（P = 0.0001）。AM和PM UNa/K的AUROC之间无差异（95%可信区间，-0.161 - 0.153，P = 0.113）。UNa/K大于1.25对预测24-h UNa大于78 mmol具有敏感性和特异性。
结果表明，任何时间随机UNa/K大于1.25是替代24-h UNa的准确、经济有效且便捷的方法。需要大型多中心队列研究来证实我们的结果。
