Kang Yeo-Jin, Bae Eun Jin, Hwang Kyungo, Jeon Dae-Hong, Jang Ha Nee, Cho Hyun Seop, Chang Se-Ho, Park Dong Jun
Department of Internal Medicine, School of Medicine Gyeongsang University, 816 Beongil 15 Jinju-daero, Jinju, Gyeongnam South Korea.
Springerplus. 2013 Oct 9;2:519. doi: 10.1186/2193-1801-2-519. eCollection 2013.
Terlipressin, as a prodrug of vasopressin, has agonistic effects on the V1 receptor and partial agonistic effects on renal vasopressin V2 receptors. However, its effects on serum sodium concentration are controversial.
This study retrospectively investigated 127 patients with liver cirrhosis to examine the incidence and risk factors for the decrease in serum sodium level following terlipressin administration.
Terlipressin was prescribed for bleeding control (99) and management of hepatorenal syndrome (28). Serum sodium level decreased from 134.0 ± 6.5 mmol/L to 130.4 ± 6.2 mmol/L during or after terlipressin treatment (P < 0.001) in all patients. In 45 patients (35.4%), the serum sodium concentration decreased by > 5 mmol/L, in 29 patients (22.8%); by 5-10 mmol/L; and in 16 patients (12.6%), by > 10 mmol/L. Five patients in the latter group showed neurological manifestations. In the univariate analysis, several factors including age, purpose of use, serum creatinine, and Model for End-Stage Liver Disease score, representing liver function, were significantly associated with the decrease in serum sodium after terlipressin administration. However, a multivariate analysis revealed that only initial sodium level was the most powerful predictor of terlipressin-induced reduction in serum sodium.
An acute reduction in serum sodium concentration was not uncommon during terlipressin treatment, and the baseline serum sodium level was closely related to the reduction in serum sodium concentration.
特利加压素作为血管加压素的前体药物，对V1受体具有激动作用，对肾血管加压素V2受体具有部分激动作用。然而，其对血清钠浓度的影响存在争议。
本研究回顾性调查了127例肝硬化患者，以探讨特利加压素给药后血清钠水平降低的发生率及危险因素。
特利加压素用于控制出血（99例）和肝肾综合征的治疗（28例）。所有患者在特利加压素治疗期间或治疗后血清钠水平从134.0±6.5 mmol/L降至130.4±6.2 mmol/L（P<0.001）。45例患者（35.4%）血清钠浓度下降>5 mmol/L，29例患者（22.8%）下降5-10 mmol/L，16例患者（12.6%）下降>10 mmol/L。后一组中有5例患者出现神经学表现。单因素分析显示，包括年龄、使用目的、血清肌酐以及代表肝功能的终末期肝病模型评分等几个因素与特利加压素给药后血清钠的降低显著相关。然而，多因素分析显示，只有初始钠水平是特利加压素诱导血清钠降低的最有力预测因素。
特利加压素治疗期间血清钠浓度急性降低并不少见，基线血清钠水平与血清钠浓度降低密切相关。
