Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, China.
Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110840, China.
Can J Gastroenterol Hepatol. 2020 Jun 22;2020:5106958. doi: 10.1155/2020/5106958. eCollection 2020.
Ascites, a common complication in cirrhosis, is prone to the development of acute kidney injury or hepatorenal syndrome and can be complicated by circulatory dysfunction after paracentesis. Terlipressin has not been considered as the mainstay treatment option for ascites in cirrhosis yet. The present work aimed to systematically review the current evidence regarding the use of terlipressin in cirrhosis with ascites and without hepatorenal syndrome. PubMed, EMBASE, and Cochrane Library databases were searched for relevant studies. Twelve studies were eligible. In 3 studies (1 randomized controlled trial and 2 single-arm studies without controls) involving 32 patients who received terlipressin for nonrefractory ascites, terlipressin improved hemodynamics by decreasing the heart rate and cardiac output and increasing the mean arterial pressure and systemic vascular resistance. In 5 studies (1 randomized controlled trial, 2 single-arm studies without controls, and 2 comparative studies with controls) involving 67 patients who received terlipressin for refractory ascites, terlipressin improved renal function by increasing the glomerular filtration rate, renal blood flow, urinary sodium, and urine output and decreasing serum creatinine. In 4 studies (4 randomized controlled trials) involving 71 patients who received terlipressin for preventing from paracentesis-induced circulatory dysfunction, terlipressin prevented from paracentesis-induced circulatory dysfunction by increasing the mean arterial pressure and systemic vascular resistance and decreasing plasma renin. Terlipressin may improve hemodynamics, severity of ascites, and renal function and prevent from paracentesis-induced circulatory dysfunction in cirrhosis with ascites and without hepatorenal syndrome. However, no study has evaluated the effect of terlipressin for prevention of acute kidney injury.
腹水是肝硬化的常见并发症，容易发生急性肾损伤或肝肾综合征，并可能在腹腔穿刺后发生循环功能障碍。特利加压素尚未被认为是肝硬化伴腹水而无肝肾综合征的主要治疗选择。本研究旨在系统回顾特利加压素在肝硬化伴腹水而无肝肾综合征中的应用的现有证据。检索了 PubMed、EMBASE 和 Cochrane Library 数据库中的相关研究。有 12 项研究符合条件。在 3 项研究（1 项随机对照试验和 2 项无对照的单臂研究）中，共 32 例患者接受特利加压素治疗非难治性腹水，特利加压素通过降低心率和心输出量以及增加平均动脉压和全身血管阻力来改善血液动力学。在 5 项研究（1 项随机对照试验、2 项无对照的单臂研究和 2 项有对照的比较研究）中，共 67 例患者接受特利加压素治疗难治性腹水，特利加压素通过增加肾小球滤过率、肾血流量、尿钠和尿量以及降低血清肌酐来改善肾功能。在 4 项研究（4 项随机对照试验）中，共 71 例患者接受特利加压素预防腹腔穿刺引起的循环功能障碍，特利加压素通过增加平均动脉压和全身血管阻力以及降低血浆肾素来预防腹腔穿刺引起的循环功能障碍。特利加压素可能改善肝硬化伴腹水且无肝肾综合征患者的血液动力学、腹水严重程度和肾功能，并预防腹腔穿刺引起的循环功能障碍。然而，没有研究评估特利加压素预防急性肾损伤的效果。
