Alessandria C, Debernardi-Venon W, Carello M, Ceretto S, Rizzetto M, Marzano A
Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Turin, Italy.
Dig Liver Dis. 2009 Apr;41(4):298-302. doi: 10.1016/j.dld.2008.09.014. Epub 2009 Jan 20.
Hepatorenal syndrome is a severe complication of cirrhosis. Treatment with terlipressin has currently the best efficacy pedigree, inducing hepatorenal syndrome reversal in a high proportion of patients. However, hepatorenal syndrome recurrence after terlipressin withdrawal is very common, especially in type 2 hepatorenal syndrome. Midodrine, an oral adrenergic vasoconstrictor, has been suggested to be an effective therapy in hepatorenal syndrome.
To analyse the impact of treatment with midodrine after hepatorenal syndrome type 2 reversal induced by terlipressin on the prevention of hepatorenal syndrome recurrence.
A case-control design was used. The outcome of 10 patients with hepatorenal syndrome type 2 treated successfully with terlipressin and then with midodrine (7.5-12.5mg/tid) was compared with that of an historical control group of hepatorenal syndrome type 2 patients responders to treatment with terlipressin. Patients and controls were matched by age, plasma renin activity (PRA) levels and severity of renal and liver failure.
Cases and controls were similar with respect to pre-treatment with terlipressin. The hepatorenal syndrome recurrence probability was the same in the two groups (cases and control: 9/10, 90%, p=ns). No significant differences were found between cases and controls with respect to serum creatinine (1.9+/-0.1mg/dl vs. 2+/-0.2mg/dl), blood creatinine clearance (28+/-5ml/min vs. 24+/-5ml/min), urinary sodium excretion (12+/-6mequiv./d vs. 19+/-4mequiv./d) and PRA levels (17+/-3ng/ml/h) vs. 20+/-3ng/ml/h) after terlipressin withdrawal (p=ns).
These results show that in patients responders to terlipressin hepatorenal syndrome recurrence is not different between patients treated with midodrine and subjects who did not receive vasoconstrictor treatment after terlipressin withdrawal. These data suggest that midodrine is not effective in preventing hepatorenal syndrome type 2 recurrence.
肝肾综合征是肝硬化的一种严重并发症。特利加压素治疗目前具有最佳的疗效记录，能使很大比例的患者的肝肾综合征得到逆转。然而，停用特利加压素后肝肾综合征复发非常常见，尤其是在2型肝肾综合征患者中。米多君，一种口服肾上腺素能血管收缩剂，已被认为是治疗肝肾综合征的有效疗法。
分析在特利加压素诱导2型肝肾综合征逆转后使用米多君治疗对预防肝肾综合征复发的影响。
采用病例对照设计。将10例成功接受特利加压素治疗后再用米多君（7.5 - 12.5毫克/每日三次）治疗的2型肝肾综合征患者的结果，与一组对特利加压素治疗有反应的2型肝肾综合征患者的历史对照组进行比较。患者和对照组按年龄、血浆肾素活性（PRA）水平以及肾衰竭和肝衰竭的严重程度进行匹配。
病例组和对照组在接受特利加压素预处理方面相似。两组的肝肾综合征复发概率相同（病例组和对照组：9/10，90%，p = 无显著差异）。在停用特利加压素后，病例组和对照组在血清肌酐（1.9±0.1毫克/分升对2±0.2毫克/分升）、血肌酐清除率（28±5毫升/分钟对24±5毫升/分钟）、尿钠排泄（12±6毫当量/天对19±4毫当量/天）和PRA水平（17±3纳克/毫升/小时对20±3纳克/毫升/小时）方面均未发现显著差异（p = 无显著差异）。
这些结果表明，在对特利加压素有反应的患者中，停用特利加压素后接受米多君治疗的患者与未接受血管收缩剂治疗者的肝肾综合征复发情况没有差异。这些数据表明米多君在预防2型肝肾综合征复发方面无效。
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