HBV相关慢加急性肝衰竭患者血清钠与病情严重程度的关系  

The Relationship Between Serum Sodium and Disease Severity of Patients with HBV Related Acute-on-chronic Liver Failure

作　　者：曹玲[1] 王崇慧[1] 占国清[1] 

机构地区：[1]湖北医药学院附属人民医院感染性疾病科,湖北十堰442000

出　　处：《湖北医药学院学报》2015年第4期357-360,共4页Journal of Hubei University of Medicine

摘　　要：目的:探讨HBV相关慢加急性肝衰竭(ACLF)患者血清钠水平与其病情严重程度的关系。方法:145例HBV相关ACLF患者,根据其血清钠水平分低钠血症轻、中、重度组和血钠正常组,观察血清钠水平与ACLF患者临床分期、并发症发生率及预后的关系。结果:145患者中,低钠血症发生率为51.7%。血清钠水平越低,ACLF晚期患者比例越高,并发症如肝性脑病、感染、低钾血症、肝肾综合征发生率越高,MELD和MELD-Na分值越高,血清钠水平与ACLF临床分期、MELD和MELD-Na分值和并发症密切相关;患者病死率为46.9%,血钠正常组、低钠血症轻、中、重度组病死率分别为31.4%、39.1%、64.5%、81.0%,低钠血症中、重度组病死率明显高于血钠正常组(P<0.01),重度组病死率也高于轻度组(P<0.01)。结论:低钠血症与HBV相关ACLF患者临床分期、MELD和MELD-Na分值、并发症及预后密切相关,监测血清钠水平可作为判断ACLF患者病情严重程度的重要指标之一。Objective To explore the relationship between serum sodium and the disease severity in patients with HBV related acute on chronic liver failure（ ACLF）. Methods Total 145 patients with HBV related ACLF were divided into mild,moderate,severe hyponatremia groups and serum sodium normal group according to their serum sodium levels. The relationship between serum sodium level and ACLF clinical stage,complications and prognosis were analyzed,respectively. Results In145 ACLF patients,the incidence rate of hyponatremia was 51. 7%. The lower the serum sodium level,the higher incidence rate of late stage ACLF following more complications including hepatic encephalopathy,infection,hypokalemia and hepatorenal syndrome,and the higher the MELD and MELD-Na score was. Serum sodium level was positively corelated with the clinical stages,MELD and MELD-Na scores and complications. The total mortality was 46. 9%,while the mortality in serum sodium normal group and mild,moderate,severe hyponatremia groups were 31. 4%,39. 1%,64. 5% and 81. 0%,respectively. The mortality in severe and moderate hyponatremia groups were obviously higher than that in serum sodium normal group（ P〈0. 01）,the mortality in severe hyponatremia group was also higher than that in mild hyponatremia group（ P〈0. 01）.Conclusion The clinical stages,MELD and MELD-Na score,complications and prognosis in patients with HBV related ACLF were correlated with hyponatremia,which could be one ofthe predictors for evaluating the severity of ACLF.

关 键 词：血清钠 肝炎 乙型 慢加急性肝衰竭 预后 

分 类 号：R512.62[医药卫生—内科学]