肝硬化合并腹水患者随机尿Na/K比值检测在临床诊疗中的应用及其意义  

Diagnostic usefulness of the random urine Na/K ratio in cirrhotic patients with ascites

作　　者：王海龙[1] 许顺姬[1] 韩学吉[1] 

机构地区：[1]延边大学医院感染科,吉林延吉133000

出　　处：《现代预防医学》2016年第9期1705-1708,共4页Modern Preventive Medicine

摘　　要：目的探讨肝硬化合并腹水患者随机尿Na／K比值的分布及能否正确反映24小时尿钠排量，并确定评价利尿剂反应的随机尿Na／K比值。方法以40例肝硬化合并腹水患者为研究对象，每个患者在早8点给利尿剂，采集24小时尿量、用利尿剂后2—4小时和7—9小时随机尿5ml，并检测24小时尿钠排量、随机尿Na／K比值以及分析随机尿Na／K比的ROC曲线。结果选择40名尿肌酐排量大于15mEq／Kg的患者进行分析，24小时平均排尿量1722．54-915．3ml（500～3500m1），24小时尿排钠量均值为107．9．4-91．2（3—366）mmoL／L，上午及下午随机尿Na／K比值分别为3．444-3．64、3．974-4．60，对24小时尿排钠量大于78mmol／L患者进行上午及下午随机尿Na／K比ROC曲线分析，上午随机尿Na／K比值ROC曲线下面积为0．861，下午随机尿Na／K比值ROC曲线下面积为0．929。分析上午及下午随机尿Na／K比值一致性，上午随机尿Na／K比值ROC曲线下面积与下午随机尿Na／K比值ROC曲线下面积之差为0．0682（95％CI=-0．161—0．153，P=0．113），统计学无差异。另外，随机尿Na／K比值在1．25—1．45以上时，可以反映24小时尿排钠量大于78mmol／L。结论随机尿Na／K比值大于1．25时，可以正确反映24小时尿钠排量大于78mmol／L，随机尿Na／K比值检测是判断利尿剂效果的方便、灵敏而特异的指标。Objective To investigate whether the random urinary Na/K ratio in cirrhotic patients with ascites, can correctly reflected the distribution of the 24 hour urinary sodium excretion rate and the random urine Na/K ratio, and determine the random urine Na/K ratio of the diuretic response. Methods To selected 40 patients with cirrhotic aseites. Each patient used diuretic at 8 am,and collected 24 hours urine volume,and collected 5ml of urine twice times ,2 -4 hours and 7 -9 hours after diuretic random urine,and detection of 24 hours urinary sodium excretion, random urine Na/K ratio and ROC curve Na/K of random urine analysis was performed. Results Forty patients with urinary ereatinine of greater than 15 mg/kg were analyzed, 24 hours average urine volume were 1,722.5 ±915.3ml （500 -3500ml） ,24 hours urinary excretion of sodium were 107.9 ±91.2 （3 -366） mmol/L,AM and PM random urine Na/K ratio were 3.44 ± 3.64,3.97 ±4.60. When 24 -h U Na were greater than 78 mmol, AUROC values for AM and PM U Na/K were 0. 861 and 0. 929, respectively （ P = O. 0001 ）. No difference was found between the AUROC for AM and PM U Na/K （95% CI = -0. 161 -0. 153 ,P = 0.113 ）. U Na/K greater than 1.25 - 1.45 was sensitive and specific for prediction of 24 - h U Na greater than 78 mmol. Conclusion Random U Na/ K which is greater than 1.25 can correctly reflect 24 - h U Na greater than 78 mmol,and random U NafK greater than 1.25 is a convenient, sensitive and specific index.

关 键 词：肝硬化 腹水 并发症 尿 钠 

分 类 号：R115[医药卫生—公共卫生与预防医学]