Wang Li, Long Yin, Li Ke-Xin, Xu Gao-Si
Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China.
Grade 2013, the Second Clinical Medical College of Nanchang University, Nanchang, Jiangxi, P. R. China.
Gastroenterol Rep (Oxf). 2019 Sep 13;8(2):111-118. doi: 10.1093/gastro/goz043. eCollection 2020 Apr.
Observational studies suggest that hepatorenal syndrome (HRS) patients who receive pharmacological therapy before orthotopic liver transplantation display a post-transplant outcome similar to those without HRS. The aim of this study was to comprehensively compare and rank the pharmacological therapies for HRS.
We reviewed PubMed, Elsevier, Medline, and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies that were published between 1 January 1999 and 24 February 2018. The primary endpoint was reversal of HRS. The secondary endpoints were the changes in serum creatinine (Scr) and serum sodium. We evaluated the different therapeutic strategies using network meta-analysis on the basis of Bayesian methodology.
The study included 24 articles with 1,419 participants evaluating seven different therapeutic strategies for HRS. The most effective treatments to induce reversal of HRS were terlipressin plus albumin, noradrenaline plus albumin, and terlipressin, which had a surface under the cumulative ranking curve (SUCRA) of 0.086, 0.151, and 0.451, respectively. The top two treatments for decreasing Scr were dopamine plus furosemide plus albumin (rank probability: 0.620) and terlipressin plus albumin (rank probability: 0.570). For increasing serum sodium, the optimal treatment was octreotide plus midodrine plus albumin (rank probability: 0.800), followed by terlipressin plus albumin (rank probability: 0.544).
Terlipressin plus albumin and dopamine plus furosemide plus albumin should be prioritized for decreasing Scr in HRS, and octreotide plus midodrine plus albumin was the most effective at increasing serum sodium. Terlipressin plus albumin showed a comprehensive effect in both decreasing Scr and increasing serum sodium.
观察性研究表明，在原位肝移植前接受药物治疗的肝肾综合征（HRS）患者移植后的结局与未患HRS的患者相似。本研究的目的是全面比较和排序治疗HRS的药物疗法。
我们检索了PubMed、爱思唯尔、医学索引数据库（Medline）以及考克兰系统评价数据库（CENTRAL），查找1999年1月1日至2018年2月24日发表的研究。主要终点是HRS的逆转。次要终点是血清肌酐（Scr）和血清钠的变化。我们基于贝叶斯方法，采用网状Meta分析评估不同的治疗策略。
该研究纳入了24篇文章，共1419名参与者，评估了七种不同的HRS治疗策略。诱导HRS逆转最有效的治疗方法是特利加压素加白蛋白、去甲肾上腺素加白蛋白和特利加压素，其累积排序曲线下面积（SUCRA）分别为0.086、0.151和0.451。降低Scr的前两种治疗方法是多巴胺加呋塞米加白蛋白（排序概率：0.620）和特利加压素加白蛋白（排序概率：0.570）。对于升高血清钠，最佳治疗方法是奥曲肽加米多君加白蛋白（排序概率：0.800），其次是特利加压素加白蛋白（排序概率：0.544）。
在降低HRS患者的Scr方面，应优先选择特利加压素加白蛋白以及多巴胺加呋塞米加白蛋白，而奥曲肽加米多君加白蛋白在升高血清钠方面最有效。特利加压素加白蛋白在降低Scr和升高血清钠方面均显示出综合效果。
