Angeli P, Volpin R, Gerunda G, Craighero R, Roner P, Merenda R, Amodio P, Sticca A, Caregaro L, Maffei-Faccioli A, Gatta A
Department of Clinical and Experimental Medicine, University of Padua, Padova, Italy.
Hepatology. 1999 Jun;29(6):1690-7. doi: 10.1002/hep.510290629.
The aim of the study was to verify the effects of the administration of an inhibitor of the release of endogenous vasodilators together with a vasoconstrictor agent in patients with hepatorenal syndrome (HRS). This new medical perspective was compared with a traditional medical approach for HRS, such as the infusion of nonpressor doses of dopamine to produce renal vasodilation. Thirteen patients with type 1 HRS were enrolled in the study. Five of them were treated with the oral administration of midodrine and the parenteral administration of octreotide. In addition, the patients received 50 to 100 mL of 20% human albumin solution daily for 20 days. Midodrine and octreotide were dosed to obtain a stable increase of at least 15 mm Hg of mean arterial pressure. Eight patients were treated with the intravenous administration of nonpressor doses of dopamine (2-4 micrograms/kg/min) and the same daily amount of albumin. After 20 days of treatment with midodrine and octreotide, an impressive improvement in renal plasma flow (RPF), glomerular filtration rate, and urinary sodium excretion was observed in patients. This was accompanied by a significant reduction in plasma renin activity, plasma vasopressin, and plasma glucagon. No side effects were observed. Three patients were discharged from the hospital. One of them successfully underwent liver transplantation. One of the two remaining patients is still alive after 472 days with a preserved renal function, and the other died from terminal liver failure after 76 days. One of the two patients who were not discharged from the hospital successfully underwent liver transplantation, and the other died from pneumonia after 29 days. Seven out of eight patients who were treated with dopamine experienced a progressive deterioration in renal function and died during the first 12 days. Only one patient recovered renal function and underwent liver transplantation. In conclusion, the long-term administration of midodrine and octreotide seems to be an effective and safe treatment of type 1 HRS in patients with cirrhosis.
本研究的目的是验证在内源性血管舒张剂释放抑制剂与血管收缩剂联合给药对肝肾综合征（HRS）患者的影响。将这种新的医学观点与HRS的传统医学方法进行比较，比如输注非加压剂量的多巴胺以产生肾血管舒张。13例1型HRS患者纳入本研究。其中5例接受米多君口服及奥曲肽胃肠外给药治疗。此外，患者连续20天每天接受50至100 mL的20%人白蛋白溶液。米多君和奥曲肽的给药剂量以使平均动脉压至少稳定升高15 mmHg。8例患者接受非加压剂量多巴胺（2 - 4微克/千克/分钟）静脉给药及相同剂量的白蛋白治疗。米多君和奥曲肽治疗20天后，观察到患者的肾血浆流量（RPF）、肾小球滤过率和尿钠排泄有显著改善。同时血浆肾素活性、血浆血管加压素和血浆胰高血糖素显著降低。未观察到副作用。3例患者出院。其中1例成功接受肝移植。其余2例患者中的1例在472天后仍存活，肾功能保留，另1例在76天后死于终末期肝功能衰竭。未出院的2例患者中的1例成功接受肝移植，另1例在29天后死于肺炎。8例接受多巴胺治疗的患者中有7例肾功能逐渐恶化，在最初12天内死亡。只有1例患者肾功能恢复并接受了肝移植。总之，长期给予米多君和奥曲肽似乎是肝硬化患者1型HRS的一种有效且安全的治疗方法。
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