肝硬化腹水合并低钠血症的临床研究

Clinical Research on Hepatocirrhosis Ascites with Hyponatremia

目的探讨低钠血症在肝硬化腹水患者中的流行状况、对预后的影响及与其他临床并发症的关系,为临床肝硬化腹水的合理治疗提供参考。方法对南昌大学第一附属医院2005年间连续收入住院的肝硬化合并腹水者共计280例进行了临床观察:采用日本日立公司7600型全自动生化分析仪进行生化指标检查,以离子选择电极法测定血清电解质浓度;采用美国通用电气公司GE LOGlC系列B超仪检测腹水程度。结果280例病例中合并低钠血症89例(31.8%);合并低钠血症组与正常血钠组比较,在肝功能Child-Pugh病情分级、死亡/恶化事件发生率、腹水程度、腹水治疗效果及并发症肝性脑病、肝肾综合征、自发性腹膜炎等方面差异均有统计学意义(P<0.01);合并低钠血症组与正常血钠组比较,其临床生化指标异常程度差异有统计学意义(P<0.01);轻度低钠血症组在死亡/恶化事件发生率上显著低于中重度低钠血症组(P<0.01),而腹水治疗效果方面显著好于中重度低钠血症组(P<0.01)。结论肝硬化腹水患者易并发低钠血症,并且增加死亡/恶化事件的发生率;低血钠与肝功能Child-Pugh病情分级、腹水程度及治疗效果与并发肝性脑病、肝肾综合征等的发生率呈正相关。

[Objective]To discuss the prevalence, influences on prognosis and relationship with other complications of hyponatremia in cirrhotic patients, and provide the reference for the reasonable treatment of hepatocirrhosis ascites. [Methods] 280 patients with hepatocirrhosis ascites in the First Affiliatod Hospital of the Nanchang University in 2005 were studied. The biochemical index was detected by type 7600 Auto Biochemical Analyzer of Hitachi Company. The electrolytes concentration of blood serum was tested with ion-selective electrode method. The situation of ascites was detected by Logic series Uhrasonography B machine of GE. [Results] 89 cases of hyponatremia were found among 280 inpatients （31.8%）. There were significant difference in Child-Pugh score, rate of death or worsen events, degree of ascites, therapeutic effect of ascites, incidence of hepatic encephalopathy and hepatorenal syndrome between the hyponatremia group and the normal group（ P 〈0.01 ）. There were significant difference in the degree of abnormalily of clinical biochemical index between the hy- ponatremia group and the normal group （ P 〈0.01 ）. The rate of death or worsen events of the mild hyponatremia group was lower than that of the mid-severe hyponatremia group obviously （ P 〈0.01 ）, and therapeutic effect of ascites of the mild hyponatremia group was better than that of the mid-severe hyponatremia group obviously （P 〈0.01）. [ Conclusion] Hyponatremia usually happened in the cirrhotic patients with ascites, and enhanced the rate of death or worsen events. Hyponatremia was positively correlated with Child-Pugh score, degree and therapeutic effect of ascites, incidence of hepatic encephalopathy and hepatorenal syndrome.