AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Australia.
Intern Med J. 2013 Mar;43(3):240-6. doi: 10.1111/imj.12032.
Hyponatraemia in liver failure is associated with increased morbidity and mortality. Improving serum sodium in liver failure has been observed in patients receiving terlipressin.
We assessed the response of hyponatraemia in patients with liver failure to terlipressin using comparative retrospective analysis.
Twenty-three patients received terlipressin for hyponatraemia after failed conservative management (median age 52 years (27-67), model for end-stage liver disease score 28 (16-38)). The median therapy was 7 days (1-27), with an average total dose of 25 mg (4-90) and a mean follow up of 51 days (5-1248). These patients were compared with 11 hyponatraemic patients managed conservatively during the same period with comparable age, baseline serum sodium and follow up. After 1 week of terlipressin therapy, serum sodium increased from a median of 120 (115-128) to 129 mmol/L (121-144) (P < 0.001), and at the end of terlipressin therapy, the serum sodium had increased significantly to 131 mmol/L (120-148) (P < 0.001). In comparison, in the conservatively managed group, the serum sodium did not increase significantly from the baseline of 123 (117-127) mmol/L. Adverse events occurred in 26% of patients receiving terlipressin, which predominantly pulmonary oedema. Importantly, more hyponatraemic patients treated with terlipressin (48%) were alive compared with the conservative group (18%), despite the latter having a significantly lower baseline median MELD score of 21 (16-30) (P = 0.008). Moreover, the transplant-free survival was higher in the terlipressin (30%) compared with the conservative group (0%).
Terlipressin is effective in treating hyponatraemia in liver failure. Importantly, terlipressin use results in better transplant-free survival but also more adverse events.
肝功能衰竭伴低钠血症与发病率和死亡率增加有关。接受特利加压素治疗的患者肝功能衰竭时血清钠升高。
我们采用比较回顾性分析评估肝功能衰竭患者低钠血症对特利加压素的反应。
23 例患者因保守治疗失败后接受特利加压素治疗低钠血症（中位年龄 52 岁（27-67），终末期肝病模型评分 28（16-38））。治疗中位数为 7 天（1-27），总剂量平均为 25 毫克（4-90），平均随访时间为 51 天（5-1248）。这些患者与同期接受保守治疗的 11 例低钠血症患者进行比较，年龄、基线血清钠和随访均具有可比性。特利加压素治疗 1 周后，血清钠从 120mmol/L（115-128）中位数增加到 129mmol/L（121-144）（P＜0.001），特利加压素治疗结束时，血清钠显著增加至 131mmol/L（120-148）（P＜0.001）。相比之下，在保守治疗组，血清钠从基线的 123mmol/L（117-127）中位数没有显著增加。接受特利加压素治疗的患者中发生了 26%的不良事件，主要为肺水肿。重要的是，与保守组（18%）相比，接受特利加压素治疗的低钠血症患者（48%）存活率更高，尽管后者的基线中位 MELD 评分明显较低，为 21（16-30）（P=0.008）。此外，特利加压素组（30%）的无移植生存率高于保守组（0%）。
特利加压素治疗肝功能衰竭伴低钠血症有效。重要的是，特利加压素的使用导致更好的无移植生存率，但也会导致更多的不良事件。
