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[目的]探讨失代偿期肝硬化患者血清钠水平与肝脏损害程度及预后的相关性。[方法]收集150例失代偿期肝硬化并低钠血症患者,根据其入院时血清钠水平将其分为轻度低钠组[(131~135)mmol/L]68例,中度低钠组[(121~130)mmol/L]50例,重度低钠组(≤120 mmol/L)32例。分析各组患者不同血钠水平与Child-Pugh分级、终末期肝病模型(MELD)评分、并发症发生率及生存期的关系。[结果]随着血钠水平降低,患者Child-Pugh分级和MELD分值明显增加,3组低钠血症间Child-Pugh分级和MELD分值差异均有统计学意义(P<0.01);重度低钠组肝性脑病、肝肾综合征、顽固性腹水、自发性腹膜炎发生率均高于中度低钠组和轻度低钠组,中度低钠组肝性脑病、顽固性腹水发生率也高于轻度低钠组(P<0.05或P<0.01);轻度低钠组1年、2年、3年的生存率高于重度低钠组(P<0.05或P<0.01),中度低钠组3年的生存率也高于重度低钠组(P<0.05)。[结论]低钠血症与失代偿期肝硬化患者肝损害程度、并发症及生存期密切相关,可以作为判断患者病情和预后的指标之一。
[Objective] To investigate the correlation between serum sodium level and liver damage and prognosis in patients with decompensated cirrhosis. [Methods] A total of 150 patients with decompensated cirrhosis and hyponatremia were enrolled and divided into mild hyponatremia group [(131-135 mmol / L)] 68 patients according to their serum sodium level at admission, 50 patients in the low sodium group [(121 ~ 130) mmol / L], and 32 patients in the severe hyponatremia group (≤120 mmol / L). The relationship between different levels of serum sodium and Child-Pugh grading, MELD score, complication rate and survival was analyzed. [Results] The Child-Pugh grading and MELD scores increased significantly with the decrease of serum sodium level. There was significant difference between Child-Pugh grading and MELD scores in 3 groups of hyponatremia (P <0.01) The incidence of hepatic encephalopathy, hepatorenal syndrome, refractory ascites and spontaneous peritonitis in patients with hyponatremia were significantly higher than those with moderate hyponatremia and mild hyponatremia, moderate hyponatremia with hepatic encephalopathy, refractory ascites (P <0.05 or P <0.01). The survival rates at 1 year, 2 years and 3 years in mild hyponatremia group were higher than those in severe hyponatremia group (P <0.05 or P <0.01) The 3-year survival rate of moderate-low sodium group was also higher than that of severe low-sodium group (P <0.05). [Conclusion] Hyponatremia is closely related to the degree of liver damage, complications and survival in patients with decompensated cirrhosis, which may be used as one of the indicators to judge the condition and prognosis of patients.