Saner F, Kavuk I, Lang H, Biglarnia R, Frühauf N R, Schäfers R F, Malagó M, Broelsch C E
Department of General Surgery and Transplantation, University of Essen, Essen, Germany.
Eur J Med Res. 2004 Feb 27;9(2):78-82.
Hepatorenal syndrome (HRS) occurs in about 20 % of patients with liver cirrhosis and ascites and is characterized by intensive renal vasoconstriction, low glomerular filtration rate but preserved tubular function and normal renal histology. The potential of terlipressin and albumin to reverse HRS after a time period of 14 days has already been shown. However, intravenous albumin is expensive (approximately 25 per 50 ml 20% albumin in Germany) and has limited availability in some settings. Therefore we used an artificial plasma substitute, Gelatinepolysuccinat, which is less expensive (approximately 12 per 500 ml). The aim of our present study was to examine the effects of terlipressin and Gelatinepolysuccinat on renal function and hemodynamics in a time period of six days.
Seven consecutive patients with cirrhosis and hepatorenal syndrome were included in a pilot study of terlipressin (6 mg /24 h iv) therapy associated with i.v. Gelatinepolysuccinat (Gelafundin 4% Infusionslösung, Company Braun, Mw: 30 000 D).
In five of the seven patients treatment was associated with a marked reduction of serum creatinine after six days (3.85 +/- 0.44 mg/dl vs.1.9 +/- 0.32 mg/dl; p< 0.018). Creatinine clearance improved (20 +/- 8.8 ml/min vs. 43 +/- 11.7 ml/min; p<0.12). There was a remarkable improvement in circulatory function in all patients, with an increase in mean arterial pressure (58+/-4.4 mmHg vs. 75 +/- 4.5 mmHg, p< 0.001). No patient developed signs of intestinal, myocardial or distal ischemia.
Terlipressin and Gelatinepolysuccinat appear to be a safe and effective treatment of hepatorenal syndrome.
肝肾综合征（HRS）见于约20%的肝硬化腹水患者，其特征为肾血管强烈收缩、肾小球滤过率降低，但肾小管功能及肾组织学正常。已有研究表明特利加压素联合白蛋白治疗14天后可逆转肝肾综合征。然而，静脉输注白蛋白价格昂贵（在德国，每50ml 20%白蛋白约25欧元），且在某些情况下供应有限。因此，我们使用了一种人工血浆代用品——明胶琥珀酸酯，其价格较为便宜（每500ml约12欧元）。本研究旨在观察特利加压素联合明胶琥珀酸酯在6天内对肾功能及血流动力学的影响。
7例连续性肝硬化合并肝肾综合征患者纳入一项关于特利加压素（6mg/24h静脉注射）联合静脉输注明胶琥珀酸酯（血定安4%输注液，贝朗公司，分子量：30000D）治疗的初步研究。
7例患者中有5例在治疗6天后血清肌酐显著降低（3.85±0.44mg/dl vs.1.9±0.32mg/dl；p<0.018）。肌酐清除率提高（20±8.8ml/min vs. 43±11.7ml/min；p<0.12）。所有患者循环功能均有显著改善，平均动脉压升高（58±4.4mmHg vs. 75±4.5mmHg，p<0.001）。无患者出现肠道、心肌或远端缺血迹象。
特利加压素联合明胶琥珀酸酯似乎是治疗肝肾综合征的一种安全有效的方法。
