低钠血症对乙肝肝硬化失代偿期患者预后的影响  

Effect of Hyponatremia on Prognosis of Patients with Decompensated Hepatitis B Cirrhosis

作　　者：马燕[1] 王晓忠[1] 延国威 何倩[1] 郭峰[1] 王宏峰[1] MA Yan;WANG Xiaozhong;YAN Guowei;HE Qian;GUO Feng;WANG Hongfeng(Department of Hepatology,Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine,Urumqi 830000,China)

机构地区：[1]新疆医科大学附属中医医院肝病科,乌鲁木齐830000

出　　处：《医学综述》2021年第4期796-803,808,共9页Medical Recapitulate

基　　金：国家自然科学基金(81760832)。

摘　　要：目的分析低钠血症对乙肝肝硬化失代偿期患者预后的影响。方法回顾性分析2017年6月至2019年12月于新疆医科大学附属中医医院住院的424例乙肝肝硬化失代偿期患者的临床资料,根据是否合并低钠血症将患者分为对照组(217例)和低钠组(207例),其中低钠组根据血清Na+水平分为3个亚组:130 mmol/L≤血清Na+<135 mmol/L为轻度低钠组;125 mmol/L≤血清Na+<130 mmoL/L为中度低钠组;血清Na+<125 mmol/L为重度低钠组。对两组患者的血清Na+水平、性别、年龄、Child-Pugh分级、终末期肝病模型(MELD)评分、4因子的纤维化指数(FIB-4)、天冬氨酸转氨酶和血小板比率指数(APRI)、丙氨酸转氨酶(ALT)、慢性肾脏病(CKD)患者比例及估算的肾小球滤过率(eGFR)等进行Cox风险比例模型分析,统计患者生存时间,观察影响患者生存状态的风险因素。结果全分析集中,两组患者的Na+水平、乙型肝炎病毒(HBV)-DNA载量、MELD评分、Child-Pugh评分、FIB-4、APRI、ALT>40 U/L患者比例、ALT水平、CKD患者比例、eGFR比较差异均有统计学意义(P<0.05);倾向性评分匹配后,两组的性别、HBV-DNA载量、ALT>40 U/L患者比例差异均有统计学意义(P<0.05)。全分析集和倾向性评分匹配后,低钠组患者180 d的累计生存率均明显低于对照组[全分析集:36.7%(76/207)比64.1%(139/217);倾向性评分匹配后:43.1%(56/130)比58.5%(76/130)],中位生存时间明显短于对照组[全分析集:(84±5)d比(127±5)d;倾向性评分匹配后:(95.80±6.90)d比(119.22±6.79)d](P<0.05)。Cox回归单因素生存分析显示,血清Na+<135 mmol/L为乙肝肝硬化失代偿期患者死亡的独立影响因素;全分析集和倾向性评分匹配后,影响乙肝肝硬化失代偿期患者死亡的独立因素还包括HBV-DNA(+)、MELD评分、CPT C级、FIB-4、APRI、ALT>40 U/L、ALT水平。Cox回归多因素生存分析显示,全分析集和倾向性评分匹配后,血清Na+<135 mmol/L、CPT C级为影响乙肝肝硬化Objective To analyze the effect of hyponatremia on prognosis of patients with decompensated hepatitis B cirrhosis.Methods The clinical data of 424 patients with decompensated who were hospitalized in Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine from Jun.2017 to Dec.2019 were retrospectively analyzed.According to the presence of hyponatremia the patients were divided into a control group(217 cases)and a hyponatremia group(207 cases).The hyponatremia group was divided into three subgroups according to the serum Na+level:the mild group with 130 mmol/L≤serum Na+concentration<135 mmol/L,the moderate group with 125 mmol/L≤serum Na+concentration<130 mmol/L,and the severe group with serum Na+concentration<125 mmol/L.Serum Na+level,gender,age,Child-Pugh classification,model fo end-stage liver disease(MELD)score,4-factor fibrosis index(FIB-4),aspartate aminotransferase and platelet ratio index(APRI),alanine transaminase(ALT),proportion of chronic kidney disease(CKD)patients and estimated glomerular filtration rate(eGFR),etc.of the two groups were analyzed by Cox risk proportional model,the survival time of the patients was recorded,and the risk factors affecting the survival status of the patients were observed.Results In the full analysis set,there were significant differences in Na+levels,HBV-DNA load,MELD score,Child-Pugh score,FIB-4,APRI,proportion of ALT>40 U/L patients,ALT levels,proportion of CKD patients,and eGFR between the two groups(P<0.05);after propensity score matching,there were significant differences in the distribution of gender,HBV-DNA load,and proportion of ALT>40 U/L patients between the two groups(P<0.05).After the full analysis set and propensity score matching,the 180 d cumulative survival rate in the hyponatremia group was significantly lower than that of the control group[the full analysis set:36.7%(76/207)vs 64.1%(139/217);after propensity score matching:43.1%(56/130)vs 58.5%(76/130)],and the median survival time was significantly shorter than that of the co

关 键 词：乙肝肝硬化 失代偿期 低钠血症 预后 生存率 

分 类 号：R512.62[医药卫生—内科学]