一項新研究發(fā)現(xiàn)測定可能接受肝移植的患者的血清鈉，能夠比以前測定的3種指標(biāo)更好地預(yù)測移植的愈后。

自從2002年開始，美國肝臟配給中心已經(jīng)根據(jù)患者的MELD(終末期肝病模型)評分，來預(yù)測等待移植的肝硬化患者的3個月死亡率，該評分使用了3種生化指標(biāo)。這3種指標(biāo)是血清膽紅素、血清肌酐、以及凝血酶原時間。當(dāng)前的研究提示添加血清鈉和低鈉血癥（血清鈉水平降低）有助于增加MELD評分預(yù)測等待移植患者死亡可能的準(zhǔn)確性。

該研究由位于阿根廷Buenos Aires的Fundacion Favaloro肝臟中心的Andres E. Ruf醫(yī)生主持，涵蓋了1995年6月～2003年1月登記等待肝移植的262例肝硬化患者。在登記的時候檢測了血清膽紅素、肌酐、和鈉用于計算MELD評分。使用了2種不同的統(tǒng)計學(xué)方法分析了等待時間未3～6月患者的血清鈉、低鈉血癥和MELD預(yù)測死亡的效能。這項研究的結(jié)果顯示：當(dāng)MELD增加血清鈉和低鈉血癥的時候，能夠顯著增加評分預(yù)測短期死亡的準(zhǔn)確性。

作者指出：“在我們的研究中，在3個月內(nèi)死亡患者中低鈉血癥發(fā)病率（63％）顯著高于3個月內(nèi)存活的患者（13％）。類似的是，患低鈉血癥的患者與那些血清鈉水平正常的患者相比更顯著的發(fā)生終末期肝衰竭。”研究人員還指出，盡管低鈉血癥最終反應(yīng)的是腎功能損害，在等待肝移植的終末期肝硬化患者中，這個指標(biāo)做為早期指標(biāo)，能夠比血清肌酐更為準(zhǔn)確地預(yù)測患者轉(zhuǎn)歸較差。

The results of this study appear in the March 2005 issue of Liver Transplantation, published by John Wiley & Sons, Inc. and is available online via Wiley InterScience.

Markers Predict Outcome of Liver Transplant
 
A new study has found that measuring serum sodium in potential liver transplant patients is better able to predict those with a poor prognosis than the three markers previously used.

Since 2002, liver allocation in the United States has been based on a patient’s score on the MELD (model for end-stage liver disease), which uses levels of three biochemical markers to predict three-month mortality in patients with cirrhosis of the liver listed for transplantation. Those three markers are serum bilirubin, serum creatinine, and prothrombin time. The current study was intended to show if adding serum sodium and hyponatremia (low sodium level in the blood) would increase the accuracy of the MELD score to predict the risk of death on the waiting list.

Led by Andres E. Ruf, M.D., of the Liver Unit of the Fundacion Favaloro in Buenos Aires (Argentina), the study included 262 patients with cirrhosis who were listed for liver transplantation between June 1995 and January 2003. Serum bilirubin, creatinine, and sodium were measured at the time of listing and used to calculate a MELD score. The efficacy of serum sodium, hyponatremia, and MELD to predict death within three and six months of listing was analyzed with two different statistical methods. Results of the study showed that when added to the MELD, serum sodium and hyponatremia significantly increased the accuracy of the score in predicting short-term mortality.

“In our study, the prevalence of hyponatremia was significantly higher in patients who died within 3 months (63%) than in those who survived 3 months (13%),” the authors noted. “Similarly, patients with hyponatremia had significantly more advanced liver failure compared to those with normal serum sodium.” They add that although hyponatremia ultimately reflects renal impairment, it appears to be a more accurate and early marker of poor outcome than serum creatinine in transplant candidates with advanced cirrhosis.

The results of this study appear in the March 2005 issue of Liver Transplantation, published by John Wiley & Sons, Inc. and is available online via Wiley InterScience.