肝衰竭并发肝肾综合征临床诊治进展

doi:10.3969/j.issn.1672-5069.2014.02.025

摘要/Abstract

摘要： 肝肾综合征（HRS）是肝衰竭、失代偿期肝硬化和肝癌晚期等重症肝病常见的严重并发症之一。HRS诊断标准虽已十分明确，但缺乏特异性诊断指标。HRS的诊断仍是一种临床排除性诊断，在实际工作中还是一个难题，因此需对HRS的早期表现提高警惕，无论是否达到HRS的诊断标准，一旦出现尿量突发显著减少伴血清肌酐水平升高，均提示HRS早期征象的发生，须及时诊断并给予及时的处理。在治疗方面，血管收缩剂联合白蛋白、TIPS、连续性肾脏替代治疗和MARS等在短暂改善肾功能的同时，主要为肝移植作准备。迄今为止，肝移植是HRS最有效的治疗方法。如不能及时接受肝移植，患者病死率达80%～100%。临床上“防重于治”。

关键词: 肝肾综合征, 肾前性氮质血症, 急性肾小管坏死, 诊断与鉴别诊断

Abstract: Hepatorenal syndrome（HRS） is one of serious complications of severe liver diseases including liver failure， decompensated cirrhosis and liver cancer. Although the diagnostic criteria for HRS has been defined clearly， the specific diagnostic indicators are lack in clinical practice. HRS is just a clinical exclusion diagnosis. Once the symptom of significant reduction in the amount of urine with increased serum creatinine levels suddenly appears，it might be the early signs of HRS. As respect to the treatment of HRS，combination of vasoconstrictors and albumin，TIPS，CRRT and MARS could improve renal function， mainly serving as a bridge for liver transplantation. So far，liver transplantation is the most effective treatment for HRS.

Key words: Hepatorenal syndrome, Pre-renal azotemia, Acute tubular necrosis, Diagnosis

李谨革综述，聂青和审校. 肝衰竭并发肝肾综合征临床诊治进展[J]. 实用肝脏病杂志, 2014, 17(2): 198-201.

Li Jinge, Nie Qinghe.. Progress in clinical diagnosis and treatment of patients with liver failure and hepatorenal syndrome[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(2): 198-201.

参考文献

[1] 聂青和.肝肾综合征诊断及治疗进展.实用临床医药杂志，2007，11（3）：10-12.
[2] Pillebout E. Hepatorenal syndrome. Nephrol Ther，2013，[Epub ahead of print].
[3] Egerod Israelsen M，Gluud LL，Bendtsen F，et al. Hepatorenal syndrome:diagnosis，treatment and prevention. Ugeskr Laeger，2013，175（22）:1562-1566.
[4] 聂青和. 重型肝炎综合治疗进展的临床教学实践及体会.实用肝脏病杂志，2006，9（2）:104-106.
[5] Salerno F，Gerbes A，Ginès P，et al. Diagnosis，prevention and treatment of hepatorenal syndrome in cirrhosis.Gut，2007，56（9）:1310-1318.
[6] 聂青和. 肝衰竭实验室检测临床价值及新指标评价.临床肝胆病杂志，2013，29（9）：666-669.
[7] Lameire NH，Bagga A，Cruz D，et al. Acute kidney injury:an increasing global concern.Lancet，2013，382（9887）:170-179.
[8] Belcher JM，Sanyal AJ，Peixoto AJ，et al. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology，2013，[Epub ahead of print]
[9] Gueutin V，Meftah A，Desbuissons G，et al. Hepatorenal syndrome:Focus. Nephrol Ther，2013，9（7）:471-480.
[10] Fabrizi F，Aghemo A，Messa P. Hepatorenal syndrome and novel advances in its management. Kidney Blood Press Res，2013，37（6）:588-601.
[11] Blokhina NV，Pasechnik IN.The modern possibilities of the hepato-renal syndrome treatment. Khirurgiia（Mosk），2013，（8）:81-85.
[12] 高禄化，聂青和. 肝衰竭继发感染临床进展. 肝脏，2013；18（1）：61-62.
[13] 聂青和，罗新栋. 肝肾综合征药物治疗及评价. 药品评价，2007，4（4）:276-278，291.
[14] 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 Hepatol，2010，53（3）:397-417.
[15] Piano S，Morando F，Fasolato S，et al. Continuous recurrence of type I hepatorenal syndrome and long-term treatment with terlipressin and albumin:a new exception to MELD score in the allocation system to liver transplantation J Hepatol，2011，55:491-496.
[16] Gluud LL，Christensen K，Christensen E，et al. Terlipressin for hepatorenal syndrome. Cochrane Database Syst Rev，2012，12:CD005162.
[17] Solà E，Cárdenas A，Ginès P.Results of pretransplant treatment of hepatorenal syndrome with terlipressin. Curr Opin Organ Transplant，2013，18（3）:265-270.
[18] Huscsak G，Kaisers UX，Laudi S.Hepatorenal syndrome. Anaesthesist，2013，62 （7）:571-582.
[19] Alessandria C，Debernardi-Venon W，Carello M，et a1.Midodrine in the prevention of hepatorenal syndrome type 2 recurrence:a case-control study. Dig Liver Dis，2009，41（4）：298-302.
[20] 王建军. 奥曲肽联合白蛋白治疗肝肾综合征的临床研究.中国现代药物应用，2013，7（17）:7-8.
[21] Tavakkoli H，Yazdanpanah K，Mansourian M. Noradrenalin versus the combination of midodrine and octreotide in patients with hepatorenal syndrome: randomized clinical trial. Int J Prev Med，2012，3（11）:764-769.
[22] 李梦东，聂青和. 肝衰竭的研究现状与展望. 实用肝脏病杂志，2013，16（1）:9-11.
[23] Wong F，Moore K，Dingemanse J，et a1. Lack of renal improvement with nonselective endothelin antagonism with tezosentan in type 2 hepatorenal syndrome. Hepatology，2008，47（1）:160-168.
[24] Cetinkaya A，Kantarceken B，Bulbuloglu E，et al. The effects of L-carnitine and N-acetylcysteine on carbontetrachloride induced acute liver damage in rats. Bratisl Lek Listy，2013，114（12）:682-688.
[25] Izzedine H，Kheder-Elfekih R，Deray G，et al. Endothelin-receptor antagonist/N-acetylcysteine combination in type 1 hepatorenal syndrome. J Hepatol，2009，50（5）:1055-1056.
[26] Kiser TH，Maclaren R，Fish DN，et al. Treatment of hepatorenal syndrome. Pharmaeotherapy，2009，29（10）:1196-1211.
[27] Lata J. Hepatorenal syndrome. World J Gastroenterol，2012，18（36）:4978-4984.
[28] Angeli P，Gines P. Hepatorenal syndrome，MELD score and liver transplantation:An evolving issue with relevant implications for clinical practice. J Hepatol，2012，57（5）:1135-1140.
[29] Kanazawa H，Sakamoto S，Fukuda A，et al. Living-donor liver transplantation with hyperreduced left lateral segment grafts:a single-center experience. Transplatation，2013，95（5）:750-754.
[30] Moller S，Aagaard NK，Schmidt L，et al. Treatment of the hepatorenal syndrome and hyponatremia in cirrhosis-part II. Dan Med J，2012，59（1）:C4372.
[31] Sourianarayanane A，Raina R，Garg G，et al. Management and outcome in hepatorenal syndrome:need for renal replacement therapy in non-transplanted patients.Int Urol Nephrol，2013，[Epub ahead of print].
[32] P cze B，Fazakas J，Zádori G，et al. MARS therapy，the bridging to liver retransplantation-Three cases from the Hungarian liver transplant program. Interv Med Appl Sci，2013，5（2）:70-75.
[33] Martin R ssle.TIPS: 25 years later. J Hepatol，2012，59（5）:1081-1093.
[34] 聂青和. 肝衰竭综合治疗进展.实用肝脏病杂志，2013；16（1）:17-19.
[35] 聂青和.肝硬化慢性肝衰竭临床治疗实践. 中国实用内科杂志， 2013，33（9）:698-701.