Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Chernivtsi, Ukraine.
Georgian Med News. 2021 May(314):125-128.
Hepatorenal syndrome is a severe complication of liver cirrhosis which is difficult to treat because of a very fast course and lack of adequate dosing recommendations due to the stage of the disease. In this study we aimed to refine the treatment of hepatorenal syndrome type I by modifying the dose of terlipressin, depending on the stage of acute kidney injury (AKI). Objective - to improve the treatment method of hepatorenal syndrome type I in patients with alcoholic liver cirrhosis by selecting the dose of terlipressin depending on the stage of acute kidney injury. For this study were enrolled 161 patients with diagnosis alcoholic liver cirrhosis, complicated with the hepatorenal syndrome. All patients were were randomly divided into control (group 1) (n=79) and study (group 2) (n=82) groups depending on the treatment received (terlipressin in the standard dosage or modified by the response-guided titration method). If the serum creatinine level decreased less than 25% from the baseline, the dose of terlipressin was gradually increased but did not accede 12 mg/24 hours. The stage of AKI was diagnosed using the criteria of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury, 2012. The risk of short term mortality (within the first 29 days) was prognosed by Model for End-Stage Liver Disease (MELD) score. The kidney function improved better in persons with a modified dose of terlipressin: the complete response rate in them was 81.7%. The response rate in those who received the standard treatment, was 66.7% only (p˂0.05). It was found that the effective dosage of terlipressin is 3 mg/24 for AKI stage I; 6 mg/24 - for AKI stage II; 12 mg/24 - for AKI stage III. The relapse of the disease occurred only in 23.2% patients with modified treatment against 40.1% in the control group (p˂0.05). Short term survival was also significantly higher in the study group - 54.9%, while in the control group it was 37% only (p˂0.05). Thus, correction of terlipressin dosage could improve the results of the treatment and reduce mortality in patients with hepatorenal syndrome type I.
肝肾综合征是肝硬化的一种严重并发症，由于疾病的阶段原因，其病程非常快，且缺乏足够的剂量建议，因此难以治疗。在这项研究中，我们旨在通过根据急性肾损伤（AKI）的阶段来调整特利加压素的剂量，从而改进 I 型肝肾综合征的治疗方法。目的-通过根据急性肾损伤的阶段选择特利加压素的剂量来改善酒精性肝硬化患者的 I 型肝肾综合征的治疗方法。本研究共纳入 161 例诊断为酒精性肝硬化合并肝肾综合征的患者。所有患者均随机分为对照组（第 1 组）（n=79）和研究组（第 2 组）（n=82），具体取决于接受的治疗（特利加压素标准剂量或根据反应指导滴定法进行修改）。如果血清肌酐水平从基线下降小于 25%，则逐渐增加特利加压素的剂量，但不超过 12mg/24 小时。AKI 的分期采用改善全球肾脏病预后组织（KDIGO）急性肾损伤临床实践指南的标准进行诊断，2012 年。短期死亡率（29 天内）的风险通过终末期肝病模型（MELD）评分进行预测。接受改良特利加压素剂量治疗的患者肾功能改善更好：他们的完全缓解率为 81.7%。接受标准治疗的患者的缓解率仅为 66.7%（p<0.05）。结果发现，特利加压素的有效剂量为 AKI Ⅰ期 3mg/24；AKI Ⅱ期 6mg/24；AKI Ⅲ期 12mg/24。仅在改良治疗的患者中发生疾病复发 23.2%，而在对照组中为 40.1%（p<0.05）。研究组的短期生存率也明显更高-54.9%，而对照组仅为 37%（p<0.05）。因此，纠正特利加压素剂量可以改善 I 型肝肾综合征患者的治疗效果并降低死亡率。
