新医学2018，Vol.49Issue(1)：1-5,5.DOI:10.3969/j.issn.0253-9802.2018.01.001
对2017年《肝硬化腹水及相关并发症的诊疗指南》的解读与商榷
Interpretation and discussion of Guidelines for diagnosis and management of ascites and associated complications in 2017
刘建军 1牛蓓2
作者信息
- 1. 056001邯郸,河北省邯郸市第二医院肝病科
- 2. 050001石家庄,河北省疾病预防与控制中心
- 折叠
摘要
Abstract
The Guidelines for diagnosis and management of ascites and associated complications were issued by the Chinese Society of Hepatology in August,2017.The following aspects should be re-considered after thoroughly reviewing the new-version guidelines.First,the international references cited in the guidelines are controversial and cannot represent the current research situations in China.Second,the increased activity of renin-angiotensin-aldosterone system (RAAS) is correlated with the decreased serum sodium and osmotic pressure,which is physiological protective response towards hyponatremia rather than the evidence for sodium-limiting therapy.Third,why do sodium-limiting intervention in the first-line treatment and administration of aldosterone antagonists cannot solve the problems of sodium retention and RAAS activity.? Fourth,the mortality rate is significantly enhanced when serum sodium ＜ 125 mmol/L.Not recommending increasing the level of serum sodium lacks of theoretical evidence.Fifth,combined use of spironolactone and furosemide can lead to the loss of sodium chloride (NaCl) up to nearly 160 mmol/d.Whether daily limit of sodium intake within 4-6 g weakens or blocks the effect of diuretics remains to be validated.Sixth,hyponatremia is the main factor affecting the prognosis of patients with end-stage liver disease.Why does it not recommend taking neasures to treat hyponatremia? The aim is to make guidelines for the treatment of cirrhosis and ascites with Chinese characteristics and intellectual property.关键词
腹水/发病机制/肾素-血管紧张素-醛固酮系统/钠潴留/诊断/肝肾综合征/限钠治疗Key words
Ascites/Pathogenesis/Renin-angiotensin-aldosterone system/Sodium retention/Diagnosis/Hepatorenal syndrome/Sodium-limiting therapy引用本文复制引用
刘建军,牛蓓..对2017年《肝硬化腹水及相关并发症的诊疗指南》的解读与商榷[J].新医学,2018,49(1):1-5,5.
