【摘要】 目的分析失代偿期肝硬化患者低钠血症与肝损伤程度、并发症及生存期的关系,探讨低钠血症对失代偿期肝硬化患者预后的评估作用。方法收集2000年1月-2005年3月于大连医科大学附属第一医院住院的首次确诊为失代偿期肝硬化的患者218例,根据血钠浓度分为3组,血钠浓度≥130 mmol/L为Ⅰ组(n=51),120 mmol/L≤血钠浓度<130 mmol/L为Ⅱ组(n=97),血钠浓度<120 mmol/L为Ⅲ组(n=70)。对患者的性别、年龄、血钠浓度、Child-Pugh分级及并发症等进行回顾性分析,并计算生存时间。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;计数资料组间比较采用χ2检验;以KaplanMeier方法进行生存时间分析,回归分析采用Cox回归模型。结果与Ⅰ、Ⅱ组比较,Ⅲ组中Child-Pugh C级患者比例最高;血钠浓度随着Child-Pugh评分增加而降低,Child-Pugh A、B、C级三者患者的血钠浓度比较差异有统计学意义(F=17.336,P<0.001),进一步两两比较差异均有统计学意义(P值均<0.05);与Ⅰ、Ⅱ组比较,Ⅲ组并发症的发生率最高,3组间肝性脑病和肝肾综合征发生率比较差异均有统计学意义(χ2值分别为17.718、6.277,P值均<0.05);Ⅲ组患者的生存时间明显短于Ⅰ组和Ⅱ组(P值均<0.05)。结论随肝损伤程度加重,失代偿期肝硬化患者低钠血症的严重程度及发生率明显增加,提示低钠血症可作为失代偿期肝硬化患者预后判断的指标之一。更多还原

【Abstract】 Objective To investigate the relationship between hyponatremia and degree of liver injury,complications and survival time,and the prognostic value of hyponatremia in patients with decompensated liver cirrhosis. Methods A total of 218 patients who were diagnosed with decompensated liver cirrhosis for the first time in The First Affiliated Hospital of Dalian Medical University from January 2000 to March2005 were enrolled in this study,and according to the serum sodium concentration,these patients were divided into group Ⅰ with a serum sodium concentration of ≥130 mmol / L( n = 51),group Ⅱ with a serum sodium concentration of ≥120 and < 130 mmol / L( n = 97),group Ⅲ with a serum sodium concentration of < 120 mmol / L( n = 70). The patients’ sex,age,serum sodium concentration,Child- Pugh class,and complications were analyzed,and the survival time was calculated. The one- way analysis of variance was applied for comparison of continuous data between groups,and the least significant difference t- test was applied for comparison between any two patients; the chi- square test was applied for comparison of categorical data between groups; the Kaplan- Meier method was applied for survival analysis,and the Cox regression model was applied for regression analysis. Results Compared with groups Ⅰ and Ⅱ,group Ⅲ had the highest proportion of patients with Child- Pugh C cirrhosis. With the increasing Child- Pugh score,the serum sodium concentration decreased; the serum sodium concentration showed significant differences across the patients with Child- Pugh A,B,and C cirrhosis( F = 17. 336,P <0. 001),and differed significantly between any two groups of these patients( all P < 0. 05). Compared with groups Ⅰ and Ⅱ,group Ⅲ had the highest incidence rate of complications,and the incidence rates of hepatic encephalopathy and hepatorenal syndrome showed significant differences across the three groups( χ2= 17. 718 and 6. 277,both P < 0. 05). Group Ⅲ had a significantly shorter survival time than groupsⅠ and Ⅱ( both P < 0. 05). Conclusion In patients with decompensated liver cirrhosis,the severity and incidence rate of hyponatremia increase significantly as liver injury becomes more severe,which suggests that hyponatremia can be used as a prognostic indicator in patients with decompensated liver cirrhosis.更多还原