Wong Florence, Pantea Lavinia, Sniderman Kenneth
Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Hepatology. 2004 Jul;40(1):55-64. doi: 10.1002/hep.20262.
Hepatorenal syndrome (HRS) is a functional renal disorder complicating decompensated cirrhosis. Treatments to date, except liver transplantation, have been able to improve but not normalize renal function. The aim of this study was to determine the efficacy of transjugular intrahepatic portosystemic stent shunt (TIPS) as a treatment for type 1 HRS in ascitic cirrhotic patients, following improvement in systemic hemodynamics with a combination of midodrine, octreotide, and albumin (medical treatment). Fourteen ascitic cirrhotic patients with type 1 HRS received medical therapy until their serum creatinine reached below 135 micromol/L for at least 3 days, followed by a TIPS if there were no contraindications. Patients were assessed before and after medical treatment, as well as at 1 week and 1, 3, 6, and 12 months post-TIPS with measurements of renal function, sodium handling, systemic hemodynamics, central blood volume, and hormonal markers. Medical therapy for 14 +/- 3 days improved renal function (serum creatinine: 233 +/- 29 micromol/L vs. 112 +/- 8 micromol/L, P =.001) and renal sodium excretion (5 +/- 2 mmol/d vs. 9 +/- 2 mmol/d, P =.002) in 10 of the 14 patients. TIPS insertion in five of the responders further improved renal function and sodium excretion, so that by 12 months post-TIPS, glomerular filtration rate (96 +/- 20 mL/min, P <.01 vs. pre-TIPS) and urinary sodium excretion (119 +/- 15 mmol/d, P <.01 vs. pre-TIPS) were normal, associated with normalization of plasma renin and aldosterone levels and elimination of ascites. In conclusion, TIPS is an effective treatment for type 1 HRS in suitable patients with cirrhosis and ascites, following the improvement of renal function with combination therapy of midodrine, octreotide, and albumin.
肝肾综合征（HRS）是一种使失代偿期肝硬化复杂化的功能性肾脏疾病。迄今为止，除肝移植外，其他治疗方法虽能改善但无法使肾功能恢复正常。本研究的目的是确定在使用米多君、奥曲肽和白蛋白联合治疗（药物治疗）改善全身血流动力学后，经颈静脉肝内门体分流术（TIPS）作为治疗腹水型肝硬化患者1型HRS的疗效。14例腹水型肝硬化1型HRS患者接受药物治疗，直至其血清肌酐至少3天低于135微摩尔/升，若没有禁忌证则随后接受TIPS治疗。在药物治疗前后以及TIPS术后1周、1、3、6和12个月对患者进行评估，测量肾功能、钠处理、全身血流动力学、中心血容量和激素标志物。14±3天的药物治疗使14例患者中的10例肾功能（血清肌酐：233±29微摩尔/升对112±8微摩尔/升，P = 0.001）和肾钠排泄（5±2毫摩尔/天对9±2毫摩尔/天，P = 0.002）得到改善。对5例有反应的患者进行TIPS植入进一步改善了肾功能和钠排泄，因此到TIPS术后12个月时，肾小球滤过率（96±20毫升/分钟，与TIPS术前相比P < 0.01）和尿钠排泄（119±15毫摩尔/天，与TIPS术前相比P < 0.01）恢复正常，同时血浆肾素和醛固酮水平恢复正常且腹水消失。总之，在米多君、奥曲肽和白蛋白联合治疗改善肾功能后，TIPS是治疗合适的肝硬化腹水患者1型HRS的有效方法。
