肝硬化患者血清钠水平与并发症及预后的相关性

Correlation of serum sodium levels with complications and prognosis in cirrhotic patients

目的:探讨终末期肝硬化患者血清钠水平与并发症及预后相关性研究,并分析ChildPugh评分及终末期肝病模型(model for endstage liver disease,MELD)与血清钠水平的关系.方法:195例终末期肝硬化患者根据其入院时血清钠水平将其分为正常组88例,低钠轻度组52例,中度组38例以及重度组17例,对比分析肝硬化患者血清钠水平与Child-Pugh评分、MELD的关系及其对患者高压并发症的影响.结果:血清钠水平越低,患者肝性脑病、低钾血症、自发性腹膜炎、肝肾综合征、消化道出血发生率越高,患者腹腔积液程度越重,患者Child-Pugh评分、MELD评分越高、平均生存时间越短,死亡率越高.血清钠水平与Child-Pugh评分(r=-0.475,P=0.005)、MELD评分(r=-0.553,P=0.002)、呈负相关,与平均生存时间(r=-0.398,P=0.007)呈正相关.结论:终末期肝病患者低钠血症与Child-Pugh评分、MELD评分、并发症发生及死亡密切相关,通过测定终末期肝病患者血清钠水平可有效判断患者病情的进展.

AIM： To investigate the correlation of serum sodium levels with complications and prognosis in cirrhotic patients, and to analyze the relationship between serum sodium levels and ChildPugh score and model for end-stage liver disease（MELD）. METHODS： One hundred and ninety-five patients with end-stage liver cirrhosis were divided into four groups according to the levels of serum sodium： a normal group（n = 88）, a mild hyponatremia group（n = 52）, a moderate hyponatremia group（n = 38） and a severe hyponatremia group（n = 17）. Child-Pugh score, MELD and complications were compared among different groups. RESULTS： Lower levels of serum sodium were associated with significantly higher incidences of hepatic encephalopathy, hypokalemia,spontaneous bacterial peritonitis, hepatorenal syndrome and gastrointestinal bleeding, more severe ascites, higher Child-Pugh score and MELD, shorter median survival and higher mortality（P〈0.05）. Serum sodium levels were negatively correlated with Child-Pugh score（r =-0.475, P = 0.005） and MELD score（r =-0.553, P = 0.002）, but positively with mean survival time（r =-0.398, P = 0.007）.CONCLUSION： Hyponatremia is closely associated with Child-Pugh score, MELD score, complications and mortality in patients with end-stage liver disease. The levels of sodium can effectively predict the progression of a patient＇s condition.