重视肝肾综合征的基础和临床研究

李妍; 陆伦根

doi:10.3969/j.issn.1001-5256.2020.11.001

重视肝肾综合征的基础和临床研究

DOI: 10.3969/j.issn.1001-5256.2020.11.001

李妍,
陆伦根

上海交通大学附属第一人民医院消化科

详细信息

中图分类号: R575.2;R692
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出版历程
- 收稿日期: 2020-07-27
- 出版日期: 2020-11-20

Emphasis on the basic and clinical research on hepatorenal syndrome

LI Yan,
LU LunGen

Department of Gastroenterology,Shanghai General Hospital,Shanghai Jiao Tong University

摘要

摘要:
肝肾综合征是失代偿期肝硬化最严重的并发症之一。晚期肝硬化患者内脏动脉血管扩张,并发肝硬化性心肌病时心输出量也减少,导致有效循环血容量减少、内源性血管收缩系统激活,肾脏血管明显收缩;兼之肾脏血流的自身调节受损,最终导致肾血流量和肾小球滤过率明显下降。全身炎症反应在肝肾综合征发病过程中也起着重要作用。肝肾综合征一经诊断应积极治疗。既往认为肝肾综合征是"功能性"肾功能不全,目前更倾向于肝肾综合征是从功能性肾功能不全到不同程度肾脏器质性改变逐步演进的一系列疾病谱。由于缺乏理想的肝肾综合征动物模型,目前对肝肾综合征病理生理学机制的探究和药理研究主要依赖临床研究,这给深入探究肝肾综合征自然史和病理生理学机制带来一定困难。主要结合近年来肝肾综合征的基础和临床研究进展及难点问题进行了讨论。
- 肝肾综合征 /
- 全身炎症反应综合征 /
- 肾上腺功能减退 /
- 治疗学
Abstract:
Hepatorenal syndrome( HRS) is one of the most severe complications of decompensated cirrhosis. Splanchnic arterial vasodilation in patients with advanced liver cirrhosis and the reduction in cardiac output due to cirrhotic cardiomyopathy may trigger the reduction in effective circulating blood volume,the activation of endogenous vasoconstrictor systems,and significant contraction of renal blood vessels;meanwhile,impairment in renal autoregulation of blood flow may finally lead to the reductions in renal blood flow and glomerular filtration rate. Systemic inflammation also plays an important role in the pathogenesis of HRS. The treatment of HRS should start as soon as it is diagnosed. In the past,HRS was considered“functional”renal insufficiency,while at present,it is considered a spectrum of diseases gradually changing from functional renal insufficiency to varying degrees of parenchymal damage. As there are still no suitable animal models of HRS,current investigations of the pathophysiology of HRS and related pharmacological research mainly rely on clinical studies,which brings difficulties in further understanding the natural history and pathophysiology of HRS. This article reviews the recent advances in the basic and clinical research on HRS and related difficulties.
- hepatorenal syndrome /
- systemic inflammatory response syndrome /
- adrenal insufficiency /
- therapeutics

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参考文献(35)

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