Nakamura Atsushi, Yoshimura Tsubasa, Ichikawa Takeshi
Hepatology, Nippon Koukan Hospital, Kawasaki, JPN.
Gastroenterology, Nippon Koukan Hospital, Kawasaki, JPN.
Cureus. 2023 Aug 30;15(8):e44419. doi: 10.7759/cureus.44419. eCollection 2023 Aug.
Hyponatremia and sarcopenia in advanced chronic liver disease (ACLD) are both associated with portal hypertension (PHT) and worse prognosis. This study investigated their interrelationship.
This retrospective study analyzed 751 patients with CLD who underwent magnetic resonance elastography (MRE) at Nippon Kokan Hospital (Kawasaki, Japan). Patients were classified and studied in five groups based on serum sodium (Na) levels: <135, 135-136, 137-138, 139-140, and >140 mEq/L. PHT was assessed by thrombocytopenia, varices, and ascites, and magnetic resonance imaging (MRI) data were used to diagnose sarcopenia.
The proportions of the five groups were 3/4/13/32/48 (%), and the mean liver stiffness (LS) was 6.6/5.7/4.2/3.2/3.2 (kPa), with significant progressive increases at Na < 139 (< 0.01). The incidence of all PHT events and sarcopenia also increased at <139 (each < 0.01). By contrast, the LS thresholds for predicting thrombocytopenia, varices, and ascites increased from 3.5 to 4.7 and 5.1, respectively, and were the same at 3.4 for low Na (<139) and sarcopenia (all < 0.01). Multivariate analysis of factors associated with low Na identified LS and sarcopenia as independent factors ( < 0.05 both). In the Cox proportional hazards model, low Na was a significant prognostic factor in ACLD (hazard ratio (HR) 5.33, < 0.01); however, the albumin-bilirubin (ALBI) score (HR 2.49) and sarcopenia (HR 4.03) were extracted in the multivariate analysis ( < 0.05 both).
Studies using MRE imaging showed that low Na levels in CLD are associated with worse prognosis, not only due to elevated LS (i.e., PHT) but also the strong association with sarcopenia.
晚期慢性肝病（ACLD）中的低钠血症和肌肉减少症均与门静脉高压（PHT）及更差的预后相关。本研究调查了它们之间的相互关系。
这项回顾性研究分析了在日本川崎日本钢管医院接受磁共振弹性成像（MRE）检查的751例慢性肝病患者。根据血清钠（Na）水平将患者分为五组：<135、135 - 136、137 - 138、139 - 140和>140 mEq/L。通过血小板减少、静脉曲张和腹水评估PHT，并使用磁共振成像（MRI）数据诊断肌肉减少症。
五组的比例分别为3/4/13/32/48（%），平均肝脏硬度（LS）分别为6.6/5.7/4.2/3.2/3.2（kPa），在Na < 139时显著逐渐升高（< 0.01）。所有PHT事件和肌肉减少症的发生率在<139时也增加（均< 0.01）。相比之下，预测血小板减少、静脉曲张和腹水的LS阈值分别从3.5增加到4.7和5.1，低钠（<139）和肌肉减少症时在3.4相同（均< 0.01）。对与低钠相关因素的多变量分析确定LS和肌肉减少症为独立因素（均< 0.05）。在Cox比例风险模型中，低钠是ACLD的显著预后因素（风险比（HR）5.33，< 0.01）；然而，在多变量分析中提取了白蛋白 - 胆红素（ALBI）评分（HR 2.49）和肌肉减少症（HR 4.03）（均< 0.05）。
使用MRE成像的研究表明，慢性肝病中的低钠水平与更差的预后相关，不仅是由于LS升高（即PHT），还与肌肉减少症密切相关。
