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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 investigate the relationship between serum sodium and its complications in patients with end-stage cirrhosis and to analyze the relationship between serum sodium and prognosis. Methods Inpatients with decompensated cirrhosis were enrolled and followed up. Analysis of the incidence of cirrhosis complications and the relationship between different serum sodium concentration. Kaplan-Meier survival analysis was used to analyze the mortality within different serum sodium concentrations. Analysis of serum sodium between different MELD values using the end-stage liver disease model score. Cox proportional hazards regression analysis of the relationship between serum sodium and prognosis. Results In 467 patients, the incidence of hyponatremia (<135mmol / L) was 50.54%. In patients with hyponatremia, in addition to gastrointestinal bleeding, the incidence of hepatorenal syndrome, hepatic encephalopathy and spontaneous peritonitis were higher than patients with serum sodium concentration ≥135mmol / L, after χ2 test, the differences were Statistical significance (P <0.05). When the serum sodium concentration was less than 125mmol / L, the incidence of large amount of ascites was 88.24%, which was significantly higher than that of 125mmol / L 135mmol / L . Patient mortality increased with decreasing serum sodium concentration. By Kaplan-Meier analysis, there was a statistically significant difference (P = 0.000) in survival between serum sodium concentrations of ≤ 125 mmol / L, (125-135 mmol / L) and ≥135 mmol / L. Cox regression analysis showed that serum sodium could be an independent predictor (P = 0.000). Conclusions There is a close relationship between hyponatremia and complications of liver cirrhosis. Hyponatremia may be one of the prognostic indicators in patients with decompensated cirrhosis.