Hepatorenal syndrome-vasoconstrictor or vasodilator?
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摘要: 肝肾综合征(HRS)是发生在严重肝脏疾病中的并发症,病死率很高。其主要特征为无其他病因的肾功能受损,肾小球滤过和肾血浆流量显著降低。在HRS的研究中,具有重大意义的发现是,内脏和周围血管循环复杂的改变、全身循环系统和肾脏局部缩管物质和舒血管物质失调,进而导致的肾脏血管的强烈收缩。近年多个临床实验结果显示缩血管物质联合白蛋白静脉输注可以改善短期治疗结果,成为临床内科治疗的热点。
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关键词:
- 肝肾综合征
Abstract: Hepatorenal syndrome (HRS) is a common complication of serious liver disease with a very high mortality, and is characterized by marked reduction in glomerular filtration rate (GFR) and renal plasma flow (RPF) in the absence of other cause of renal failure.The researches of great significance showed that HRS related to renal vasoconstriction with predominant peripheral arterial vasodilation, resulting from complex changes in splanchnic and general circulations as well as systemic and renal vasoconstrictors and vasodilators.Recently, some clinical trials have indicated that vasoconstrictor combined with albumin infusion have emerged as the preferred pharmacologic therapies for management of HRS and could improve short-term outcome.-
Key words:
- hepatorenal syndrome
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[1]Arroyo V, Ginès P, Gerbes AL, et al.Definition and diagnosticcriteria of refractory ascites and hepatorenal syndrome in cirrhosis.International Ascites Club[J].Hepatology, 1996, 23 (1) :164-176. [2]Salerno F, Gerbes A, Gines P, et al.Diagnosis, prevention andtreatment of hepatorenal syndrome in cirrhosis[J].Gut, 2007, 56 (9) :1310-1318. [3]Runyon BA.Management of adult patients with ascites due to cirrho-sis:an update[J].Hepatology, 2009, 49 (6) :2087-2107. [4]European Association for the Study of the Liver.EASL clinical prac-tice guidelines on the management of ascites, spontaneous bacterialperitonitis, and hepatorenal syndrome in cirrhosis[J].J Hepatol, 2010, 53 (3) :397-417. [5]Sanyal AJ, Boyer T, Garcia-Tsao G, et al.A randomized, pro-spective, double-blind, placebo-controlled trial of terlipressin fortype 1 hepatorenal syndrome[J].Gastroenterology, 2008, 134 (5) :1360-1368. [6]Martín-LlahíM, Pépin MN, Guevara M, et al.Terlipressin and al-bumin vs albumin in patients with cirrhosis and hepatorenal syn-drome:a randomized study[J].Gastroenterology, 2008, 134 (5) :1352-1359. [7]中华医学会.肝衰竭诊疗指南[J].中华肝脏病杂志, 2006, 14 (9) :643-646. [8]Alessandria C, Venon WD, Marzano A, et al.Renal failure in cir-rhotic patients:role of terlipressin in clinical approach to hepatorenalsyndrome type 2[J].Eur J Gastroenterol Hepatol, 2002, 14 (12) :1363-1368. [9]Duvoux C, Zanditenas D, Hézode C, et al.Effects of noradrenalinand albumin in patients with type I hepatorenal syndrome:a pilotstudy[J].Hepatology, 2002, 36 (2) :374-380. [10]Sharma P, Kumar A, Shrama BC, et al.An open label, pilot, ran-domized controlled trial of noradrenaline versus terlipressin in thetreatment of type 1 hepatorenal syndrome and predictors of response[J].Am J Gastroenterol, 2008, 103 (7) :1689-1697. [11]Skagen C, Einstein M, Lucey MR, et al.Combination treatment withoctreotide, midodrine, and albumin improves survival in patients withtype 1 and type 2 hepatorenal syndrome[J].J Clin Gastroenterol, 2009, 43 (7) :680-685. [12]Nazar A, Pereira GH, Guevara M, et al.Predictors of response totherapy with terlipressin and albumin in patients with cirrhosis andtype 1 hepatorenal syndrome[J].Hepatology, 2010, 51 (1) :219-226.
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