Research state and prospect of hyponatremia in cirrhosis
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摘要: 稀释性低钠血症(DH)是肝硬化腹水患者常发生的一个并发症,并与难以控制的腹水、肝性脑病(HE)、自发性细菌性腹膜炎(SBP)及肝肾综合征(HRS)密切相关。肝硬化患者DH,轻者可表现为疲乏无力、肌张力低,重者可出现低钠性脑病,表现为认知、运动功能障碍,严重者可出现抽搐或昏迷。肝移植前存在DH的患者,其移植后的并发症和病死率明显增加。治疗上限制水摄入、输入白蛋白以纠正DH,严重低钠血症,静脉补充高张钠。几种非肽V2受体拮抗剂有望在肝硬化患者DH的治疗上发挥一定的作用。Abstract: Dilutional hyponatremia (DH) is a common complication of patients diagnosed with cirrhosis and is closely related with refractory ascites, hepatic encephalopathy (HE) , spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS) .The common symptoms of hepatocirrhotic patients with mild dilutional hyponatremia are fatigue and muscle weakness.The clinical manifestations of severe cases can be encephalopathy characterized by cognitive and motor disturbances, even convulsion or coma.If the patients preparing for liver transplantation have dilutional hyponatremia, the complications and death occur more often after the transplantation.The treatments for dilutional hyponatremia include water restriction and albumin transfusion.Injection of hypertonic saline is necessary for treating severe hyponatremia.Several non-peptide V2 receptor antagonists are likely to play a role in the treatment of dilutional hyponatremia.
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Key words:
- liver cirrhosis /
- hyponatremia
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[1]Angeli P, Wong F, Watson H, et al.Hyponatremia in cirrhosis:results of a patient population survey[J].Hepatology, 2006, 44 (6) :1535-1542. [2]Gine's P, Berl T, Bernardi M, et al.Hyponatremia in cirrhosis:from pathogenesis to treatment[J].Hepatology, 1998, 28 (3) :851-864. [3]Schrier RW.Water and sodium retention in edematousdisorders:role of vasopressin and aldosterone[J].Am JMed, 2006, 119 (Suppl 1) :S47-53. [4]Ishikawa SE, Schrier RW.Pathogenesis of hyponatremia:therole of arginine vasopressin in cirrhosis[M].Oxford:BlackwellScience, 2005:305-314. [5]Esteva-Font C, Baccaro ME, Fernández-Llama P, et al.Aquaporin-1 and aquaporin-2 urinary excretion in cirrhosis:relationship with ascites and hepatorenal syndrome[J].Hepatology, 2006, 44 (6) :1555-1563. [6]Gerbes AL, Gülberg V, Ginès P, et al.Therapy of hy-ponatremia in cirrhosis with a vasopressin receptorantagonist:a randomized double-blind multicenter trial[J].Gastroenterology, 2003, 124 (4) :933-939. [7]Berl T, Verbalis J.Pathophysiology of water metabolism.In:Brenner&Rector's The Kidney[M].Philadelphia:Elsevier, 2004, 857-920. [8]Halperin ML, Kamel KS.A new look at an old problem:therapy of chronic hyponatremia[J].Nat Clin Pract Nephrol, 2007, 3 (1) :2-3. [9]Restuccia T, Gómez-Ansón B, Guevara M, et al.Effects ofdilutional hyponatremia on brain organic osmolytes andwater content in patients with cirrhosis[J].Hepatology, 2004, 39 (6) :1613-1622. [10]Córdoba J, Gottstein J, Blei AT.Chronic hyponatremiaexacerbates ammonia-induced brain edema in rats after porto-caval anastomosis[J].J Hepatol, 1998, 29 (4) :589-594. [11]Murphy N, Auzinger G, Bernel W, et al.The effect ofhypertonic sodium chloride in intracranial pressure inpatients with acute liver failure[J].Hepatology, 2004, 39 (2) :464-470. [12]Abbasoglu O, Goldstein RM, Vodapally MS, et al.Livertransplantation in hyponatremic patients with emphasison central pontine myelinolysis[J].Clin Transplant, 1998, 12 (3) :263-269. [13]Londo?o MC, Guevara M, Rimola A, et al.Hyponatremiaimpairs early posttransplantation outcome in patientswith cirrhosis undergoing liver transplantation[J].Gastroenterology, 2006, 130 (4) :1135-1143. [14]Ruiz-del-Arbol L, Monescillo A, Jimenéz W, et al.Paracentesis-induced circulatory dysfunction:mechanismand effect on hepatic hemodynamics in cirrhosis[J].Gastroenterology, 1997, 113 (2) :579-586. [15]Wong F, Blei AT, Blendis LM, et al.A vasopressin receptorantagonist (VPA-985) improves serum sodium concentrationin patients with hyponatremia:a multicenter, randomized, placebo-controlled trial[J].Hepatology, 2003, 37 (1) :182-191. [16]Schrier RW, Gross P, Gheorghiade M, et al.Tolvaptan, aselective oral vasopressin V2-receptor antagonist, forhyponatremia[J].N Engl J Med, 2006, 355 (20) :2099-2112.
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