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中华肾病研究电子杂志 ›› 2015, Vol. 04 ›› Issue (04) : 169 -172. doi: 10.3877/cma.j.issn.2095-3216.2015.04.001

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肝肾综合征的诊治现状
李荣山1()   
  1. 1. 030012 太原,山西省人民医院肾内科
  • 出版日期:2015-08-28
  • 通信作者: 李荣山

Progress in diagnosis and treatment of hepatorenal syndrome

Rongshan Li1,()   

  1. 1. Department of Nephrology, Shanxi Provincial People′s Hospital, Taiyuan, Shanxi 030012, China
  • Published:2015-08-28
  • Corresponding author: Rongshan Li
  • About author:
    Corresponding author: Li Rongshan, Email:
引用本文:

李荣山. 肝肾综合征的诊治现状[J]. 中华肾病研究电子杂志, 2015, 04(04): 169-172.

Rongshan Li. Progress in diagnosis and treatment of hepatorenal syndrome[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(04): 169-172.

肝肾综合征(HRS)是重症肝病患者常见的严重并发症之一,病死率极高。尽管国际腹水俱乐部于2007年修订了HRS的诊断标准,但因缺乏特异性的诊断指标,目前HRS尤其是早期阶段,仍然很难被确诊。近年来,血管收缩药物联合白蛋白治疗Ⅰ型HRS取得了较大的成就,改变了HRS内科治疗几乎无效的状态。然而,药物治疗效果有限,目的主要是为肝移植作准备,肝移植术仍是HRS患者目前唯一可靠的、有效的治疗手段。随着对HRS认识的提高,相关学者越来越强调早期预防HRS的重要性。

Hepatorenal syndrome (HRS) is one of common serious complications in patients with severe liver diseases, with a very high mortality rate. The International Ascites Club updated the diagnostic criteria for HRS in 2007, but HRS is still difficult to be diagnosed especially at its early stage because of the lack of specific diagnostic indicators in clinical practice. In recent years, the treatment with vasoconstrictors in association with albumin has been much successful for type I HRS, which has changed the recognition that HRS is an irreversible and untreatable condition by medical management. However, the effect of the drug-therapy is limited, which mainly serves as a bridge for liver transplantation. So far, liver transplantation is the only effective treatment for HRS. With improved understanding of HRS, early prevention of HRS has been considered to be more and more important.

表1 Ⅰ型与Ⅱ型肝肾综合征的区别
[1]
Pillebout E. Hepatorenal syndrome [J]. Nephrol Ther, 2014, 10(1): 61-68.
[2]
Salerno F, Gerbes A, Gines P, et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis [J]. Gut, 2007, 56(9): 1310-1318.
[3]
Prabhu MV, Sukanya B, Santosh PB, et al. The hepatorenal syndrome - a review] [J]. G Ital Nefrol, 2014, 31(3). pii: gin/31.3.12.
[4]
Barbano B, Sardo L, Gigante A, et al. Pathophysiology, diagnosis and clinical management of hepatorenal syndrome: from classic to new drugs [J]. Curr Vasc Pharmacol, 2014, 12(1):125-135.
[5]
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis [J]. J Hepatol, 2010, 53(3): 397-417.
[6]
Runyon B A. Management of adult patients with ascites due to cirrhosis: update 2012 [J/OL]. Hepatology,2013. DOI 10.1002/hep.00000.
[7]
Verna EC, Brown RS, Farrand E, et al. Urinary neutrophil gelatinase-associated lipocalin predicts mortality and identifies acute kidney injury in cirrhosis [J]. Dig Dis Sci, 2012, 57(9): 2362-2370.
[8]
Gungor G, Ataseven H, Demir A, et al. Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study [J]. Liver Int, 2014, 34(1): 49-57.
[9]
Hasper D, Jorres A. New insights into the management of hepatorenal syndrome [J]. Liver Int, 2011, 31 (Suppl 3): 27-30.
[10]
Sola E, Cardenas A, Gines P. Results of pretransplant treatment of hepatorenal syndrome with terlipressin [J]. Curr Opin Organ Transplant, 2013, 18(3): 265-270.
[11]
Gluud LL, Christensen K, Christensen E, et al. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome [J]. Hepatology, 2010, 51(2): 576-584.
[12]
Hiremath SB, Srinivas LD. Survival benefits of terlipressin and non-responder state in hepatorenal syndrome: a meta-analysis [J]. Indian J Pharmacol, 2013, 45(1): 54-60.
[13]
Rice JP, Skagen C, Said A. Liver transplant outcomes for patients with hepatorenal syndrome treated with pretransplant vasoconstrictors and albumin [J].Transplantation, 2011, 91(10): 1141-1147.
[14]
Boyer TD, Sanyal AJ, Garcia-Tsao G, et al. Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1 [J]. Liver Transpl, 2011, 17(11): 1328-1332.
[15]
Ghosh S, Choudhary NS, Sharma AK, et al. Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study [J]. Liver Int, 2013, 33(8): 1187-1193.
[16]
Sourianarayanane A, Raina R, Garg G, et al. Management and outcome in hepatorenal syndrome: need for renal replacement therapy in non-transplanted patients [J]. Int Urol Nephrol, 2014, 46(4): 793-800.
[17]
Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome [J]. Hepatology, 2004, 40(1): 55-64.
[18]
Angeli P, Gines P. Hepatorenal syndrome, MELD score and liver transplantation: an evolving issue with relevant implications for clinical practice [J]. J Hepatol, 2012, 57(5): 1135-1140.
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