血清钠与肝硬化并发症及其预后的关系

Relationship of serum sodium to complications and prognosis of liver cirrhosis

目的探讨终末期肝硬化患者血清钠特点及与并发症之间的相互关系,分析血清钠与预后的关系。方法选取失代偿期肝硬化患者的住院资料进行登记和随访。分析肝硬化并发症的发生与不同血清钠浓度之间的关系。利用Kaplan-Meier生存分析方法分析不同血清钠浓度内病死率。利用终末期肝病模型评分分析不同MELD值之间血清钠特点。利用Cox比例风险回归分析血清钠与预后的关系。结果在467例患者中,低钠血症(<135mmol/L)的发生率为50.54%。在低钠血症患者中,除消化道出血外,肝肾综合征、肝性脑病和自发性腹膜炎的发生率均高于血清钠浓度≥135mmol/L的患者,经过χ2检验,其差异均有统计学意义(P<0.05)。当血清钠浓度≤125mmol/L时,大量腹水的发生率为88.24%,明显高于125mmol/L<血清钠<135mmol/L和血清钠≥135mmol/L时大量腹水的发生率(P=0.000)。患者病死率随血清钠浓度的降低而增加。通过Kaplan-Meier分析,血清钠浓度≤125mmol/L、(125～135)mmol/L和≥135mmol/L三个级别之间的生存率存在统计学差异(P=0.000)。Cox回归分析得出,血清钠可以成为一个独立的预测因子(P=0.000)。结论低钠血症与肝硬化并发症之间有密切联系,低钠血症可以作为判断失代偿期肝硬化患者预后的指标之一。

Objective To explore the relationship of serum sodium to complications and prognosis in patients with end stage liver cirrhosis. Methods The data from de-compensated cirrhosis patients in our hospital were selected to be analyzed. Serum sodium concentration was classified. The relationship between incidences of complications and serum sodium concentration was analyzed. M ortality in different sodium concentrations was determined by the Kaplan-M eier survival analysis. Using the model of end stage liver disease（ M ELD） ,characteristics of serum sodium in different M ELD values were analyzed. The relationship between serum sodium and prognosis was analyzed by Cox proportional hazard regression. Results In 467 patients,the incidence of hyponatremia （ 〈 135 mmol /L） was 50. 54% . Except for bleeding from the digestive tract,incidences of other complications,such as hepatorenal syndrome,hepatic encephalopathy and spontaneous peritonitis,were higher in hyponatremia than in a sodium concentration ≥135 mmol /L （ P 〈 0. 05） . When the concentration was ≤125 mmol /L,the incidence of a large amount of ascites was 88. 24% ,which was obviously higher than that at other concentrations（ P = 0. 000） . M ortality of cirrhosis patients was increased when the serum sodium concentration decreased. The Kaplan-M eier survival analysis showed that mortality was statistically different in concentrations of ≤125 mmol /L,（ 125-135） mmol /L and ≥135 mmol /L （ P = 0. 000） . Sodium concentration could be one of the independent prognostic predictors by the Cox proportional hazard regression（ P = 0. 000） . Conclusion The complications closely correlate with hyponatremia,which can be one of the prognostic predictors in patients with end stage liver disease.