乙肝肝硬化失代偿期腹水患者血钠水平与其并发症及临床预后的关系

Relationship between complications and clinical prognosis and serum sodium level of patients with decompensated hepatitis-B related cirrhosis and ascites

目的:探求乙肝肝硬化失代偿期腹水患者血钠水平与其并发症及临床预后的关系。方法:回顾性分析2015年5月至2016年10月年收治的乙型肝炎肝硬化失代偿期伴腹水患者98例病例资料,据血钠水平分为低钠血症组与正常组,通过分层分析,对比不同组别患者入院时肝肾功能、血清白蛋白含量、Child-pugh评分、肝纤维化程度及并发症情况,治疗2周后,对比两组患者腹水疗效及出院后预后。结果:98例患者中血钠水平<130 mmol/L者41例(41.8%)。低钠血症组入院时转氨酶、血肌酐、总胆红素、凝血酶原时间、Child-pugh评分均明显高于正常组,血清白蛋白含量则低于血钠水平正常组,差异均具有统计学意义(P<0.05)。低钠血症组与正常组入院时伴肝性脑病、肝肾综合征、消化道出血、自发性腹膜炎比例差异均具有统计学意义(分别为24.4%vs.7.0%,19.5%v s.5.3%,26.8%v s.10.5%及24.4%v s.8.8%;P<0.05)。入院14 d,两组腹水治疗效果中显效比例分别为73.2%,89.5%(χ~2=4.4 2 1,P=0.0 3 6);出院后1 2个月随访期间内,两组病死率分别为3 6.6%,15.8%(χ~2=5.577,P=0.018)。结论:血钠水平与肝硬化失代偿期病情密切相关,低钠血症患者病情较重,疗效与预后较差。

Objective： To explore the relationship between serum sodium level and complications clinical prognosis of patients with decompensated hepatitis-B related cirrhosis patients with ascites. Methods： Retrospective analysis was conducted on 98 admitted cases with decompensated liver cirrhosis from May 2015 to October. 2016, and hyponatremia group and normal group were arranged according to serum sodium level. Through stratified analysis, liver and renal function, serum albumin, Child-pugh score, degree of liver fibrosis and complications on admission were compared between the two groups. Two weeks after treatment, efficacies for ascites were also compared, besides, prognosis of 2 groups were noted and compared after discharge. Results： Forty eight cases（41.8%） of 98 patients whose serum sodium levels 130 mmol/L. In the hyponatremia group, the levels of transaminase（ALTAST）, creatinine（Cr）, total bilirubin（TBIL）, prothrombin time（PT）, Child-pugh score on admission were significantly higher than those in the normal group, serum albumin level was lower than that in the normal group, the differences were statistically significant（P0.05）. The hepatic encephalopathy, hepatorenal syndrome, gastrointestinal bleeding, spontaneous bacterial peritonitis rates in the hyponatremia group and the normal group were 24.4% vs. 7.0%, 19.5% vs.5.3%, 10.5% vs. 26.8% and 24.4% vs. 8.8% respectively, the differences were statistically significant（P0.05）. Fourteen days after admission, efficacies for ascites of the two groups were 73.2% vs. 89.5%（χ~2=4.421, P=0.036）; within 12-month follow-up, fatality rates of the two groups were 36.6% vs. 15.8%（χ~2=5.577, P=0.018）. Conclusion： Serum sodium level is closely related with decompensated liver cirrhosis status, hyponatremia patients with more serious condition, poor efficacy and prognosis.