Alessandria C, Ottobrelli A, Debernardi-Venon W, Todros L, Cerenzia M Torrani, Martini S, Balzola F, Morgando A, Rizzetto M, Marzano A
Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Torino, Italy.
J Hepatol. 2007 Oct;47(4):499-505. doi: 10.1016/j.jhep.2007.04.010. Epub 2007 May 24.
BACKGROUND/AIMS: Treatment of hepatorenal syndrome (HRS) is based on vasoconstrictors. Terlipressin is the one with the soundest evidence. Noradrenalin has been suggested as an effective alternative. The current study was aimed at assessing the efficacy and safety of noradrenalin vs terlipressin in patients with HRS.
Twenty-two consecutive cirrhotic patients with HRS (9 with HRS type 1; 13 with HRS type 2) were included. Patients were randomly assigned to be treated with noradrenalin (0.1-0.7 microg/kg/min) and albumin (10 patients) or with terlipressin (1-2 mg/4h) and albumin (12 patients). Treatment was administered until HRS reversal or for a maximum of two weeks. Patients were followed-up until liver transplantation or death.
Reversal of HRS was observed in 7 of the 10 patients (70%) treated with noradrenalin and in 10 of the 12 patients (83%) treated with terlipressin, p=ns. Treatment led in both groups to a significant improvement in renal and circulatory function. No patient developed signs of myocardial ischemia.
Data from this unblinded, pilot study suggest that noradrenalin is as effective and safe as terlipressin in patients with HRS. These results would support the use of noradrenalin, a cheap and widely available drug, in the management of these patients.
背景/目的：肝肾综合征（HRS）的治疗基于血管收缩剂。特利加压素是证据最充分的一种。去甲肾上腺素已被认为是一种有效的替代药物。本研究旨在评估去甲肾上腺素与特利加压素治疗HRS患者的疗效和安全性。
纳入22例连续性肝硬化合并HRS患者（9例为1型HRS；13例为2型HRS）。患者被随机分配接受去甲肾上腺素（0.1 - 0.7微克/千克/分钟）和白蛋白治疗（10例患者）或特利加压素（1 - 2毫克/4小时）和白蛋白治疗（12例患者）。治疗持续至HRS逆转或最长两周。对患者进行随访直至肝移植或死亡。
接受去甲肾上腺素治疗的10例患者中有7例（70%）出现HRS逆转，接受特利加压素治疗的12例患者中有10例（83%）出现HRS逆转，p值无统计学意义。两组治疗均使肾脏和循环功能显著改善。无患者出现心肌缺血迹象。
这项非盲法的初步研究数据表明，去甲肾上腺素在治疗HRS患者方面与特利加压素一样有效且安全。这些结果将支持使用去甲肾上腺素这种廉价且广泛可得的药物来治疗这些患者。
