The effects of diuretic use and the presence of ascites on muscle cramps in patients with cirrhosis: a nationwide study.
The effects of diuretic use and the presence of ascites on muscle cramps in patients with cirrhosis: a nationwide study.
复制标题
利尿剂的使用和腹水的存在对肝硬化患者肌肉痉挛的影响：一项全国性研究。
DOI：
10.1007/s00535-020-01694-8
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发表时间：
2020
期刊：
影响因子：
6.3
通讯作者：
Koike K.
中科院分区：
文献类型：
--
作者：
Sawada Y;Shiraki M;Iwasa M;Hiraoka A;Nakanishi H;Karino Y;Nakajima T;Miyaaki H;Kawaguchi T;Yoshiji H;Okita K;Koike K.
背景：据报道，肝硬化患者服用利尿剂和出现腹水与肌肉痉挛有关；然而，临床证据有限。本研究旨在确定肌肉痉挛是否是利尿剂引起的并发症，腹水是否是肌肉痉挛的一个相关因素。方法2017年6月至2018年12月，共纳入来自日本10家医院的1064例成年肝硬化患者。所有患者均完成关于痉挛的问卷调查。采用生物电阻抗法分析细胞外水（ECW）比。采用Logistic回归分析利尿剂给药及ECW比值对痉挛的影响。结果使用利尿剂的患者比未使用利尿剂的患者有更高的发生率、频率、更强的疼痛和更长的痉挛持续时间。在多变量分析中，利尿剂的使用和ECW比值值≥0.4与痉挛的存在、频率、强度或持续时间无显著相关。然而，在限于Child-Pugh B或C级的患者中，利尿剂的使用与痉挛频率显著相关。结论：肌肉痉挛不是肝硬化患者使用利尿剂的并发症；然而，在那些仅限于Child-Pugh B或C的患者中，利尿剂的使用是影响痉挛频率的一个因素。此外，没有发现腹水和痉挛之间的联系。
BackgroundAdministration of diuretics and the presence of ascites in patients with cirrhosis were reported to be associated with muscle cramps; however, the clinical evidence is limited. This study aimed to determine whether muscle cramps are a diuretic-induced complication and whether ascites was a factor related to muscle cramp.MethodsA total of 1064 adult patients with cirrhosis were enrolled from 10 hospitals in Japan between June 2017 and December 2018. A questionnaire regarding cramps was completed by all patients. The ratio of extracellular water (ECW) was analyzed using the bioelectrical impedance analysis. Logistic regression analysis was performed to analyze the effects of diuretic administration and the ECW ratio on cramps.ResultsPatients using diuretics had a higher incidence rate, higher frequency, stronger pain, and longer duration of cramps than those who did not. In the multivariate analysis, diuretic administration and the ECW ratio values ≥ 0.4 were not significantly associated with the presence, frequency, intensity, or duration of cramps. However, in the case of patients limited to Child–Pugh B or C, diuretic use was significantly correlated with the cramp frequency.ConclusionsThese results demonstrated that muscle cramps were not a complication of diuretic use in patients with cirrhosis; however, in those limited to Child–Pugh B or C, diuretic use was a factor that affected the frequency of cramps. Moreover, no association was found between the presence of ascites and cramps.