Zhang Jingqiao, Liu Jie, Wu Yunhai, Romeiro Fernando Gomes, Levi Sandri Giovanni Battista, Zhou Xinmiao, Li Miaomiao, Qi Xingshun
Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, China.
Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, China.
Ann Transl Med. 2020 Mar;8(6):340. doi: 10.21037/atm.2020.02.135.
Renal dysfunction is a serious morbidity in cirrhotic patients with acute upper gastrointestinal bleeding (AUGIB). Terlipressin is the first-line treatment choice for acute variceal bleeding and hepatorenal syndrome (HRS). This study aimed to assess the effect of terlipressin on renal function in patients with liver cirrhosis and AUGIB.
We retrospectively reviewed 40 cirrhotic patients with AUGIB treated with terlipressin by an attending physician between January 2016 and June 2018. We analyzed the change of renal function parameters, including cystatin C (CysC) and creatinine (Cr), during the use of terlipressin and after terlipressin was stopped. We also identified the factors associated with renal function improvement in patients without active bleeding during the use of terlipressin.
During the use of terlipressin, CysC value was significantly reduced (1.3±0.8 1.1±0.7, P=0.001); Cr value was reduced, but the reduction was not statistically significant (68.8±24 65.5±23, P=0.817); the rate of CysC reduction was significantly higher in patients treated with terlipressin than those treated with somatostatin/octreotide (73.1% 0%, P=0.005); the rate of Cr reduction was not significantly different between patients treated with terlipressin and somatostatin/octreotide (61.5% 20%, P=0.148); no factor associated with CysC reduction was identified; higher hemoglobin, red blood cell, and platelet and lower prothrombin time and international normalized ratio at baseline were significantly associated with Cr reduction. After terlipressin was stopped, neither CysC nor Cr value was significantly reduced (P=0.852 and P=0.296).
Terlipressin may be beneficial on preventing renal function impairment in cirrhotic patients with AUGIB.
肾功能不全是肝硬化合并急性上消化道出血（AUGIB）患者的一种严重并发症。特利加压素是急性静脉曲张出血和肝肾综合征（HRS）的一线治疗选择。本研究旨在评估特利加压素对肝硬化合并AUGIB患者肾功能的影响。
我们回顾性分析了2016年1月至2018年6月期间由主治医师用特利加压素治疗的40例肝硬化合并AUGIB患者。我们分析了使用特利加压素期间及停用特利加压素后肾功能参数的变化，包括胱抑素C（CysC）和肌酐（Cr）。我们还确定了在使用特利加压素期间无活动性出血患者肾功能改善的相关因素。
使用特利加压素期间，CysC值显著降低（1.3±0.8对1.1±0.7，P = 0.001）；Cr值降低，但降低无统计学意义（68.8±24对65.5±23，P = 0.817）；特利加压素治疗患者的CysC降低率显著高于生长抑素/奥曲肽治疗患者（73.1%对0%，P = 0.005）；特利加压素治疗患者与生长抑素/奥曲肽治疗患者的Cr降低率无显著差异（61.5%对20%，P = 0.148）；未发现与CysC降低相关的因素；基线时较高的血红蛋白、红细胞和血小板以及较低的凝血酶原时间和国际标准化比值与Cr降低显著相关。停用特利加压素后，CysC和Cr值均未显著降低（P = 0.852和P = 0.296）。
特利加压素可能有助于预防肝硬化合并AUGIB患者的肾功能损害。
