II Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22 D-81675 Munich, Germany.
Ann Hepatol. 2012 Mar-Apr;11(2):232-9.
Hepatorenal syndrome type I (HRS I) may be a consequence of circulatory dysfunction in cirrhotic patients with portal hypertension. This uncontrolled interventional pilot study examines the hemodynamic and renal effects of large volume plasma expansion in HRS I.
14 cirrhotic patients (8 m, 6 f, age 60 (58-65) years) with HRS I received large volume plasma expansion with up to 400 mL of 20% human albumin solution per 12 over 48 h under hemodynamic monitoring by transpulmonary thermodilution. Creatinine clearances (ClCreat) were calculated for 12-h periods. Plasma expansion was withheld if criteria of volume overload [Extravascular lung Water Index (ELWI) > 9 mL/kg or Global End-Diastolic Volume Index (GEDI) > 820 mL/m(2)] were met. Paracentesis was performed according to clinical necessity and treatment continued for 48 h thereafter. Serum creatinine values were observed for 12 days.
Patients received 1.6 (1.5-2.0) g of albumin per kg bodyweight and day for 48 to 96 h. During the treatment period, GEDVI [724 (643-751) mL/m(2) vs. 565 (488-719) mL/m(2) ; p = 0.001], cardiac index (CI) [4.9 (4.1-6.15) L/min/m(2) vs. 3.9 (3.4-5.0) L /min/m(2) ; p = 0.033], urinary output [25 (17-69) mL/h vs. 17 (8-39) mL/h; p = 0.016) and ClCreat [20 (15-47) vs. 12 (6-17); p = 0.006] increased whereas systemic vascular resistance index (SVRI), plasma renin activity (PRA) and plasma aldosterone were significantly reduced. At 48 h there were two complete responses (serum creatinine < 133 µmol/L) and on day 12, 8 patients had a complete response.
HRS I may respond to large volume plasma expansion with or without paracentesis.
肝性肾损伤 I 型（HRS I）可能是肝硬化伴门静脉高压患者循环功能障碍的结果。本项未对照的介入性初步研究探讨了大体积血浆扩充对 HRS I 的血液动力学和肾脏影响。
14 名 HRS I 肝硬化患者（8 名男性，6 名女性，年龄 60（58-65）岁）在血液动力学监测下接受每 12 小时多达 400ml 的 20%人血白蛋白溶液扩充，持续 48 小时。在 12 小时期间计算肌酐清除率（ClCreat）。如果出现容量超负荷标准[血管外肺水指数（ELWI）>9ml/kg 或全心舒张末期容积指数（GEDI）>820ml/m2]，则停止血浆扩充。根据临床需要进行腹腔穿刺，并在其后继续治疗 48 小时。观察血清肌酐值 12 天。
患者接受了 1.6（1.5-2.0）g/kg 体重/天白蛋白，持续 48 至 96 小时。在治疗期间，GEDVI [724（643-751）ml/m2 比 565（488-719）ml/m2；p=0.001]、心指数（CI）[4.9（4.1-6.15）L/min/m2 比 3.9（3.4-5.0）L/min/m2；p=0.033]、尿量[25（17-69）ml/h 比 17（8-39）ml/h；p=0.016]和 ClCreat [20（15-47）ml/min 比 12（6-17）ml/min；p=0.006]增加，而全身血管阻力指数（SVRI）、血浆肾素活性（PRA）和血浆醛固酮显著降低。在 48 小时时有 2 例完全反应（血清肌酐<133µmol/L），在第 12 天有 8 例完全反应。
HRS I 可能对有或无腹腔穿刺的大体积血浆扩充有反应。
