Solà Elsa, Sanchez-Cabús Santiago, Rodriguez Ezequiel, Elia Chiara, Cela Raquel, Moreira Rebeca, Pose Elisa, Sánchez-Delgado Jordi, Cañete Nuria, Morales-Ruiz Manuel, Campos Francisco, Balust Jaume, Guevara Mónica, García-Valdecasas Juan Carlos, Ginès Pere
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Liver Transpl. 2017 May;23(5):583-593. doi: 10.1002/lt.24763.
The alfapump system has been proposed as a new treatment for the management of refractory ascites. The system removes ascites from the peritoneal cavity to urinary bladder, producing a continuous low-volume paracentesis. The aim of the study is to investigate the effects of treatment with the alfapump™ system on kidney and circulatory function in patients with cirrhosis and refractory ascites. This was a prospective study including 10 patients with cirrhosis and refractory ascites. Primary outcomes were changes in glomerular filtration rate (GFR), as assessed by isotopic techniques, and changes in circulatory function assessed by arterial pressure, cardiac output, and activity of vasoconstrictor systems. Secondary outcomes were the need for large-volume paracentesis and adverse events. Follow-up was 1 year. GFR decreased significantly from 67 mL/minute/1.73 m (41-90 mL/minute/1.73 m ) at baseline to 45 mL/minute/1.73 m (36-74 mL/minute/1.73 m ) at month 6 (P = 0.04). Mean arterial pressure and cardiac output did not change significantly; however, there was a marked increase in plasma renin activity and norepinephrine concentration (median percent increase with respect to baseline +191% and 59%, respectively). There were 68 episodes of complications of cirrhosis in 8 patients during follow-up, the most frequent being acute kidney injury. In conclusion, treatment with alfapump™ system was associated with marked activation of endogenous vasoconstrictor systems and impairment of kidney function. The chronological relationship observed between kidney impairment and vasoconstrictor systems activation after device insertion suggests a cause-effect relationship, raising the possibility that treatment with alfapump impairs effective arterial blood volume mimicking a postparacentesis circulatory dysfunction syndrome. In this context, the potential role of albumin in counteracting these effects should be investigated in future studies. Liver Transplantation 23 583-593 2017 AASLD.
阿尔法泵系统已被提议作为治疗顽固性腹水的一种新方法。该系统将腹水从腹腔引流至膀胱，实现持续的小量腹腔穿刺放液。本研究的目的是探讨使用阿尔法泵™系统治疗对肝硬化合并顽固性腹水患者肾脏和循环功能的影响。这是一项前瞻性研究，纳入了10例肝硬化合并顽固性腹水患者。主要结局指标为采用同位素技术评估的肾小球滤过率（GFR）变化，以及通过动脉压、心输出量和血管收缩系统活性评估的循环功能变化。次要结局指标为大量腹腔穿刺放液的需求和不良事件。随访时间为1年。GFR从基线时的67毫升/分钟/1.73平方米（41 - 90毫升/分钟/1.73平方米）显著降至第6个月时的45毫升/分钟/1.73平方米（36 - 74毫升/分钟/1.73平方米）（P = 0.04）。平均动脉压和心输出量无显著变化；然而，血浆肾素活性和去甲肾上腺素浓度显著升高（相对于基线的中位数增加百分比分别为+191%和59%）。随访期间，8例患者发生了68次肝硬化并发症，最常见的是急性肾损伤。总之, 使用阿尔法泵™系统治疗与内源性血管收缩系统的显著激活及肾功能损害有关。在装置植入后观察到的肾功能损害与血管收缩系统激活之间的时间关系提示存在因果关系，这增加了使用阿尔法泵治疗损害有效动脉血容量从而模拟腹腔穿刺后循环功能障碍综合征的可能性。在此背景下，白蛋白在抵消这些影响方面的潜在作用应在未来研究中进行探讨。《肝脏移植》2017年第23卷第583 - 593页，美国肝病研究学会 。
