Xu Xiangbo, Lin Su, Yang Yida, Chen Yu, Liu Bang, Li Bimin, Wu Yunhai, Meng Fanping, Zhu Qiang, Li Yiling, Tang Shanhong, Yuan Shanshan, Shao Lichun, Qi Xingshun
Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang, China.
Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Expert Opin Drug Saf. 2020 May;19(5):641-647. doi: 10.1080/14740338.2020.1734558. Epub 2020 Feb 26.
: Terlipressin can effectively control acute gastrointestinal bleeding (GIB) in cirrhotic patients by acting on the V1 receptors, but may lead to the development of dilutional hyponatremia by acting on the V2 receptors.: This retrospective multicenter study enrolled 674 cirrhotic patients with acute GIB in whom serum sodium concentrations were tested before and during the use of terlipressin. ΔSodium reduction ≥5 mmol/L, hyponatremia (sodium <130 mmol/L), and severe hyponatremia (sodium <125 mmol/L) during the use of terlipressin were evaluated. Logistic regression analyses were employed to identify the risk factors.: The incidence of Δsodium reduction ≥5 mmol/L, hyponatremia, and severe hyponatremia was 37.1%, 26.3%, and 13.0%, respectively. All of them were not significantly associated with in-hospital mortality (p = 0.973; p = 0.789; p = 0.887). In multivariate logistic regression analyses, the independent risk factors of Δsodium reduction ≥5 mmol/L were higher baseline sodium concentration, lower serum creatinine and prothrombin time, and larger dosage of terlipressin; those of hyponatremia were lower baseline sodium concentration and longer duration of terlipressin; those of severe hyponatremia were lower baseline sodium concentration and prothrombin time and longer duration of terlipressin.: Hyponatremia was common in cirrhotic patients with acute GIB treated with terlipressin, but might not significantly increase the in-hospital mortality.
特利加压素可通过作用于V1受体有效控制肝硬化患者的急性胃肠道出血（GIB），但也可能通过作用于V2受体导致稀释性低钠血症的发生。本回顾性多中心研究纳入了674例肝硬化急性GIB患者，在使用特利加压素之前及期间检测其血清钠浓度。评估了使用特利加压素期间钠降低≥5 mmol/L、低钠血症（血清钠<130 mmol/L）和严重低钠血症（血清钠<125 mmol/L）的情况。采用逻辑回归分析来确定危险因素。钠降低≥5 mmol/L、低钠血症和严重低钠血症的发生率分别为37.1%、26.3%和13.0%。所有这些情况均与住院死亡率无显著相关性（p = 0.973；p = 0.789；p = 0.887）。在多变量逻辑回归分析中，钠降低≥5 mmol/L的独立危险因素为较高的基线钠浓度、较低的血清肌酐和凝血酶原时间以及较大剂量的特利加压素；低钠血症的危险因素为较低的基线钠浓度和较长的特利加压素使用时间；严重低钠血症的危险因素为较低的基线钠浓度和凝血酶原时间以及较长的特利加压素使用时间。低钠血症在接受特利加压素治疗的肝硬化急性GIB患者中很常见，但可能不会显著增加住院死亡率。
