Pomier-Layrargues Gilles, Paquin Sarto C, Hassoun Ziad, Lafortune Michel, Tran Albert
Liver Unit, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Hepatology. 2003 Jul;38(1):238-43. doi: 10.1053/jhep.2003.50276.
The hepatorenal syndrome (HRS) is related to vasoconstriction of the renal cortex induced by systemic hypovolemia that follows splanchnic vasodilatation as the primary event in the cascade of hemodynamic changes associated with portal hypertension. We evaluated the effects of octreotide, a splanchnic vasoconstrictor, on HRS in cirrhotic patients. We compared the effects of octreotide infusion (50 microg/h) to placebo using a randomized, double-blind, cross-over design over 2, 4-day periods. Nineteen patients were included, and 14 patients could complete the 2 phases of the study (group 1: placebo first; n = 8 and group 2: octreotide first; n = 6) The end point of the study was to evaluate improvement in renal function as defined by a 20% decrease in serum creatinine value after a 4-day treatment as compared with baseline. In all the patients, a normal central venous pressure was maintained by daily intravenous administration of 2 units of albumin. The 2 groups were similar with regard to demographic data and liver and kidney function parameters at baseline. Improvement in renal function was observed in 2 patients after the placebo and 1 patient after octreotide infusion in group 1 and in 2 patients after octreotide infusion and 1 patient after placebo in group 2 (P = not significant). In addition, treatment with octreotide infusion did not result in significant changes in creatinine clearance, daily urinary sodium, plasma renin activity, plasma aldosterone and glucagon levels, or renal and mesenteric artery resistance indices as measured by Doppler ultrasonography. In conclusion, the present study demonstrates that, under our experimental conditions, octreotide infusion combined with albumin is not effective for the treatment of HRS in cirrhotic patients.
肝肾综合征（HRS）与门静脉高压相关血流动力学变化级联反应中作为首要事件的内脏血管扩张后出现的全身血容量减少所诱发的肾皮质血管收缩有关。我们评估了内脏血管收缩剂奥曲肽对肝硬化患者肝肾综合征的影响。我们采用随机、双盲、交叉设计，在两个4天周期内比较了奥曲肽输注（50微克/小时）与安慰剂的效果。纳入了19例患者，14例患者能够完成研究的两个阶段（第1组：先给予安慰剂；n = 8；第2组：先给予奥曲肽；n = 6）。研究的终点是评估与基线相比，经过4天治疗后血清肌酐值降低20%所定义的肾功能改善情况。在所有患者中，通过每日静脉输注2单位白蛋白维持正常中心静脉压。两组在基线时的人口统计学数据以及肝肾功能参数方面相似。第1组中，2例患者在接受安慰剂治疗后和1例患者在接受奥曲肽输注后肾功能有改善；第2组中，2例患者在接受奥曲肽输注后和1例患者在接受安慰剂后肾功能有改善（P = 无显著差异）。此外，奥曲肽输注治疗并未导致肌酐清除率、每日尿钠、血浆肾素活性、血浆醛固酮和胰高血糖素水平发生显著变化，也未导致通过多普勒超声测量的肾动脉和肠系膜动脉阻力指数发生显著变化。总之，本研究表明，在我们的实验条件下，奥曲肽输注联合白蛋白对肝硬化患者肝肾综合征的治疗无效。
