肝硬化合并低钠血症的处理

Research progress in the management of hyponatremia in cirrhosis

肝硬化低钠血症是指血清钠浓度<130 mmol/L,但也有学者认为该定义过于严格,应当放宽为<135 mmol/L。其最重要的病理生理特征性改变是精氨酸加压素(AVP)的分泌增加,使肾脏清除无溶质水的能力受损,导致水、钠潴留。鉴于低钠血症临床处理困难,高度选择性精氨酸加压素V2受体拮抗剂普坦药物的发现,特别是托伐普坦的上市,对肝硬化低钠血症产生了良好的临床治疗效果。大量研究表明,短期甚至长期应用托伐普坦是安全有效的,且其是目前惟一可以用于临床肝硬化低钠血症的普坦类药物。

Hyponatremia in liver cirrhosis is defined by a serum sodium concentration of less than 130 mmol/L,but some scholars think that the definition is too strict and serum sodium concentration should be less than 135 mmol/L. Hyponatrem- ia in liver cirrhosis is characterized by excessive renal retention of water relative to sodium due to reduced solute-free water clearance. The primary cause is increased release of arginine vasopressin. As clinical hyponatremia is usually difficult to treat,the occurrence of vanptans, particullarlly tolvaptan, a highly selective arginine vasopressin V2 receptor antagonist on hyponatremia cirrhosis is of importance in clinical practice. A number of studies have suggested short-term, few of them even with long-term, application tolvaptan is safe and effective, and it is currently the sole vanptan to be used in clinical hy-ponatremia in patients with cirrhosis.