Barakat Ashraf Abd El-Khalik, Metwaly Amna Ahmed, Nasr Fatma Mohammad, El-Ghannam Maged, El-Talkawy Mohamed Darwish, Taleb Hoda Abu
Intensive Care Department, Theodor Bilharz Research Institute, Giza, Egypt.
Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Giza, Egypt.
Electron Physician. 2015 Oct 19;7(6):1349-58. doi: 10.14661/1349. eCollection 2015 Oct.
Hyponatremia is common in cirrhosis. The relationship between hyponatremia and severity of cirrhosis is evidenced by its close association with the occurrence of complications, the prevalence of hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, refectory ascites, and hepatic hydrothorax. The aim of this study was assess the impact of hyponatremia on the occurrence of both liver-related complications and the hemodynamic cardiovascular dysfunction.
This prospective study was conducted in 2015 on 74 patients with liver cirrhosis. The patients were from the Gastroenterology and Hepatology Department of Theodor Bilharz Research Institute in Giza, Egypt. The patients were divided into three groups according to their serum level of sodium. Group 1 included 30 patients with serum sodium >135 meq/L, group 2 included 24 patients with serum sodium between135 and 125 meq/L, and group 3 included 20 patients with serum sodium <125 meq/L. For each of the patients, we conducted aclinical examination, laboratory investigations, chest X-ray, ECG, abdominal sonar, and echocardiography.
Hyponatremia was found in 59.46% of our cirrhotic patients, and they showed significantly increased Model for End-Stage Liver Disease (MELD) score, MELD-Na score, QTc interval, Pulmonary vascular resistance (PVR) and inferior vena cava (IVC) collapsibility, and decreased SVR and IVC diameter. Also hepatic encephalopathy, ascites, renal failure, infectious complications, and pleural effusion were significantly more common in hyponatremic cirrhotic patients.
In cirrhosis, hyponatremia is more common in severe cardiovascular dysfunction and associated with increased risk of hepatic encephalopathy, ascites, illness severity scores, renal failure, infectious complications, and pleural effusion. We recommend selective oral administration of vasopressin V2-receptor antagonist, tolvaptan, which acts to increase the excretion of free water, thereby resolving hypervolemic hyponatremia and may have the potential to improve outcomes in these patients.
低钠血症在肝硬化患者中很常见。低钠血症与肝硬化严重程度之间的关系体现在其与并发症的发生、肝性脑病、肝肾综合征、自发性细菌性腹膜炎、顽固性腹水及肝性胸水的患病率密切相关。本研究旨在评估低钠血症对肝脏相关并发症及血流动力学心血管功能障碍发生的影响。
2015年对74例肝硬化患者进行了这项前瞻性研究。患者来自埃及吉萨的西奥多·比尔哈兹研究所胃肠病学和肝病科。根据血清钠水平将患者分为三组。第1组包括30例血清钠>135 meq/L的患者，第2组包括24例血清钠在135至125 meq/L之间的患者，第3组包括血清钠<125 meq/L的20例患者。对每位患者进行了临床检查、实验室检查、胸部X光、心电图、腹部超声及超声心动图检查。
我们的肝硬化患者中有59.46%存在低钠血症，他们的终末期肝病模型（MELD）评分、MELD-Na评分、QTc间期、肺血管阻力（PVR）和下腔静脉（IVC）塌陷度显著增加，而全身血管阻力（SVR）和IVC直径减小。此外，低钠血症的肝硬化患者中肝性脑病、腹水、肾衰竭、感染性并发症及胸腔积液明显更为常见。
在肝硬化患者中，低钠血症在严重心血管功能障碍中更为常见，且与肝性脑病、腹水、疾病严重程度评分、肾衰竭、感染性并发症及胸腔积液的风险增加相关。我们建议选择性口服血管加压素V2受体拮抗剂托伐普坦，其作用是增加自由水的排泄，从而解决高容量性低钠血症，并可能有改善这些患者预后的潜力。
