Objective To investigate the relationship of hyponatremia with the survival situation and complica-tions of portal hypertension in patients with end-stage liver disease. Methods Two hundred and fifty-two patients of end-stage liver disease in the Department of Gastroenterology in our hospital from Jan. 2011 to Jan. 2014 were enrolled in the study, which were divided into four groups according to the levels of serum sodium:normal group (>135 mmol/L, n=102), mild hyponatremia group (131~135 mmol/L, n=58), moderate hyponatremia group (121~130 mmol/L, n=42), se-vere hyponatremia group (≤120 mmol/L, n=50). The relationship between hyponatremia and the complications of portal hypertension, Child-Pugh score, model for end-stage liver disease (MELD) were analyzed. All the patients were fol-lowed up for 6~22 months, and the survival of patients were observed. Results The incidence for complications of por-tal hypertension in the three hyperlipidemia groups [39.93%(22/58), 59.52%(25/42), 76.00%(42/50)] was significantly higher than that in normal group [11.76%(12/102)], and the incidence in severe hyponatremia group was significantly higher than that in moderate hyponatremia group and mild hyponatremia group (P<0.05). The volume of ascitic fluid [(458.36 ± 72.48) ml, (1252.25 ± 245.25) ml, (2453.18 ± 285.96) ml], MELD score [(12.92 ± 2.93), (19.78 ± 3.92), (25.97 ± 4.79)], Child-Pugh score [(9.32 ± 2.18), (12.85 ± 2.36), (15.86 ± 3.42)], and fatality rate [8.62% (5/58), 23.81% (10/42), 28.00%(14/50)] in the three hyponatremia groups were significantly higher than those in normal group [(358.96±45.23) ml, (9.98±2.15), (5.18±1.84), 0.98%(1/102)], P<0.05, while the average survival time was significantly shorter than that in normal group [(14.25±2.39) months, (11.88±1.45) months, (8.96±063) months vs (19.82±2.45) months], with statistically significant difference (P<0.05). Logistic-regression analysis showed that the levels of sodium, MELD score, Child-Pugh score were independent risk factors for death of patients with end-stage liver cirrhosis. Conclusion In patients with end-stage liver cirrhosis, hyponatremia is closely correlated with portal hypertension, ascites level, MELD score, and Child-Pugh score. It is an independent risk factor for death of the patients and can serve as an index for prognostic evalu-ation.%目的 探讨低钠血症与终末期肝病患者生存状况和门静脉高压并发症的关系.方法 选取本院消化内科2011年1月至2014年1月收治的252例肝硬化终末期肝病患者为研究对象,根据患者入院时血清钠水平分为正常组(>135 mmol/L) 102例,轻度低钠组(131~135 mmol/L) 58例,中度低钠组(121~130 mmol/L) 42例,重度低钠组(≤120 mmol/L) 50例.分析各组患者的血清钠水平与门静脉高血压并发症、Child-Pugh评分及终末期肝病模型(MELD)的关系,对患者随访6~22个月,观察患者生存现状.结果 三低钠血症组(轻、中、重度低钠组)门静脉高压并发症发生率[39.93%(22/58)、59.52%(25/42)、76.00%(42/50)]明显高于正常组[11.76%(12/102)],且重度低钠组也明显高于中度低钠组及轻度低钠组,两两比较差异均有统计学意义(P<0.05);三低钠血症组腹水量[(458.36±72.48) ml、(1252.25±245.25) ml、(2453.18±285.96) ml]、MELD评分[(12.92±2.93)分、(19.78±3.92)分、(25.97±4.79)分]、Child-Pugh评分[(9.32±2.18)分、(12.85±2.36)分、(15.86±3.42)分]及病死率[8.62%(5/58)、23.81%(10/42)、28.00%(14/50)]均明显高于正常组[(358.96±45.23) ml、(9.98±2.15)分、5.18±1.84)分、0.98%(1/102)],而平均生存时间则明显短于正常组[(14.25±2.39)个月、(11.88±1.45)个月、(8.96±063)个月vs (19.82±2.45)个月],两两比较差异均有统计学意义(P<0.05);Logistic多因素分析显示,血钠水平、MELD评分、Child-Pugh评分是终末期肝硬化患者死亡的独立危险因素.结论 低钠血症与终末期肝硬化患者门静脉高压、腹水水平、MELD评分、Child-Pugh评分有密切的关系,是患者死亡的独立危险因素,可作为终末期肝硬化患者预后的评价指标.
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