肝肾综合征的治疗进展

李妍; 陆伦根; 蔡晓波

doi:10.3969/j.issn.1001-5256.2020.11.004

肝肾综合征的治疗进展

DOI: 10.3969/j.issn.1001-5256.2020.11.004

上海交通大学附属第一人民医院消化科

基金项目:

国家重大科技专项（2018ZX09201016）；

详细信息

中图分类号: R575.2;R692
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出版历程
- 收稿日期: 2020-08-24
- 出版日期: 2020-11-20

Advances in the treatment of hepatorenal syndrome

Department of Gastroenterology,The First People's Hospital Affiliated to Shanghai Jiao Tong University

Research funding:

摘要

摘要:
肝肾综合征是失代偿期肝硬化常见的严重并发症之一,是一组继发于有效血容量下降、内源性血管活性物质失衡、肾血流量下降,以肾功能不全为主要表现的临床综合征。肝肾综合征临床上主要表现为肾血流量和肾小球滤过率下降,肾脏组织学往往无显著变化。肝肾综合征一经诊断应尽早开始治疗。目前临床工作中肝肾综合征的治疗手段主要包括:（1）一般支持治疗,积极处理原发疾病及诱因;（2）药物治疗,包括白蛋白和血管活性药物;（3）肾脏替代治疗;（4）分子吸附再循环系统;（5）经颈静脉肝内门体分流术;（6）肝移植。肝移植是肝肾综合征治疗的最佳方案,药物治疗、肾脏替代治疗等通常作为肝移植术前的过渡期治疗。其中,白蛋白联合特利加压素是目前肝肾综合征药物治疗的首选方案。系统综述了肝肾综合征在治疗方面的新概念和新进展。
- 肝肾综合征 /
- 药物疗法 /
- 肾替代疗法 /
- 肝移植
Abstract:
Hepatorenal syndrome is one of the major complications of decompensated cirrhosis secondary to the reduction in effective blood volume,imbalance of endogenous vasoactive substances,and the reduction in renal blood flow,with renal insufficiency as the main manifestation. In clinical practice,hepatorenal syndrome mainly manifests as the reduction in renal blood flow and glomerular filtration rate,with no marked changes in renal histology. The treatment of hepatorenal syndrome should start as soon as it is diagnosed. Current therapeutic modalities include the following:( 1) general supportive therapies for primary diseases and predisposing factors;( 2) pharmacotherapy,including albumin and vasoactive agents;( 3) renal replacement therapy;( 4) molecular adsorbent recirculating system;( 5) transjugular intrahepatic portosystemic shunt;( 6) liver transplantation. Liver transplantation is the optimal regimen for the treatment of hepatorenal syndrome,and the other methods including pharmacotherapy and renal replacement therapy are often used as transitional therapies before liver transplantation. Albumin combined with terlipressin is currently the preferred regimen of pharmacotherapy for hepatorenal syndrome. This article reviews the new concepts and advances in the treatment of hepatorenal syndrome.
- hepatorenal syndrome /
- drug therapy /
- renal replacement therapy /
- liver transplantation

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参考文献(28)

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