肝硬化腹腔积液患者低钠血症与血管加压素和人尾加压素Ⅱ关系研究

目的测定肝硬化腹腔积液患者的血管加压素（vasopressin，VP）、人尾加压素Ⅱ（humanurotensin-Ⅱ，hu-Ⅱ）水平，了解其对肝硬化低钠血症的诊断意义，并探讨低钠血症的发生机制。方法检测57例肝硬化患者和8例功能性消化不良患者的血钠、尿钠、血尿渗透压、血浆VP和hu-Ⅱ水平，并将低钠血症与Child—pugh分级、腹腔积液、肝性脑病、血尿渗透压及VP、hu-Ⅱ等指标进行相关性分析。结果肝硬化患者低钠血症发生率为41．8％。低钠血症越明显，肝功能状态越差，腹腔积液和肝性脑病的发生例数越多，血浆VP、hu-Ⅱ水平在肝硬化患者明显增加，血钠、尿钠、血渗透压、尿渗透压均与VP和hu-Ⅱ水平呈负相关（P〈0．05）。尿一血渗透压比值与VP、hu-Ⅱ水平无相关性（P〉0．05）。结论肝硬化患者肝功能状态越差，血钠水平越低。血浆VP、hu-Ⅱ水平增加是形成肝硬化低钠血症的机制之一，同时又能够作为判断稀释性或低钠性低钠血症的参考指标。

Correlation of Hyponatremia with Vasopressin and Human Urotensin-II in Patients with Cirrhosis Ascites

Objective To explore the mechanism of hyponatremia and the effects of vasopressin (VP),human urotensin-II (hU-II) on cirrhosis ascites.Methods The levels of serum sodium,urine sodium,urine osmolality,plasma VP and hU-II were determined in 57 patients with liver cirrhosis (LC) and 8 with functional dyspepsia.The correlation of hyponatremia with Child-puph grade,ascites,hepatic encephalopathy,urine osmolality and VP and hU-II etc.was analyzed.Results The incidence of hyponatremia was 41.8% in LC patients.The more obvious hyponatremia was,the worse liver function was,and the more frequently ascites and hepatic encephalopathy occurred.Plasma VP and hU-II increased remarkably in LC patients,and serum sodium,urine sodium,serum osmolality and urine osmolality were negatively correlated with VP,hU-II (P＜0.05 ),but there was not correlation between urine-blood osmolality ratio and VP,hU-II (P＞0.05).Conclusion The worse the liver function is,the lower serum sodium is.The increase of serum VP,hU-II,one of the mechanisms of cirrhosis ascites,can be regarded as a reference indicator for determination of dilution or sodium hyponatremia.