经颈内静脉肝内门体分流术治疗肝肾综合征临床研究

Therapy of hepatorenal syndrome with transjugular intrahepatic portosystemic shunt

[目的]观察经颈内静脉肝内门体分流术(TIPS)治疗肝肾综合征(HRS)的临床疗效,探讨其可能的作用机制。[方法]10例确诊为HRS患者行TIPS,分别于术前及术后测门静脉压力、门静脉内径及血流速度、尿钠排泄、尿量、血肌酐(Cr)、尿素氮(BUN)及血Cr清除率;术前及术后7 d测定肾素(PRA)、血管紧张素Ⅱ(AT-Ⅱ)、醛固酮(ALD)水平。[结果]TIPS术后门静脉压力、门静脉内径及血流速度分别为(2.3±0.3)kPa、(1.26±0.04)cm、(44.2±14.5)cm/s,与术前比较均P<0.01。BUN、血Cr、尿钠排泄、血Cr清除率及尿量手术前后差异有统计学意义(均P<0.01)。术后PRA、AT-Ⅱ、ALD分别为(67.12±25.28)、(138.02±58.54)、(597.37±284.25)ng/L,与术前比较,P<0.01,<0.05,<0.05。[结论]TIPS治疗HRS近期疗效明显,其作用可能与血容量的增加和肾素-血管紧张素-醛固酮系统改变有关。

[Objective]To evaluate the effectiveness of transjugular intrahepatic portosystemic shunt （TIPS） in the treatment of hepatorenal syndrome （HRS） and explore its mechanism. [Methods] Ten patients of cirrhosis with HRS were treated with TIPS. The portal vein pressure, portal diameter, portal blood flow velocity, as well as urinary sodium excretion, urinary output, serum creatinine, blood urea nitrogen, creatinine clearance were measured before and after TIPS. Plasma renin activity, angiotensin Ⅱ, plasma aldosterone were measured before and 1 week after the procedure. [Results] The portal vein pressure dropped from （4. 3±0. 7） kilopascal （kPa） to （2. 3±0. 30） kPa （P〈0. 01）. The portal diameter decreased from （1. 62±0. 08） cm to （1. 26± 0. 04） （P〈0. 01）. The portal blood flow velocity increased from （10. 8±3. 6） cm/s to （44. 2± 14. 5） （P〈0. 01）. Blood urea nitrogen went down and urinary sodium excretion went up after treatment （P〈0. 01）. Serum creatinine went down and creatinine clearance and urinary output went up after treatment （P〈0. 01）. The concentration of plasma renin activity, angiotensin-Ⅱ, plasma aldosterone decreased from （150. 56±46. 17）, （216.26±99.08）, （911.47±348. 69） ng/L to （67. 12±25.28） （P〈0.01）, （138. 02±58. 54）, （597. 37±284. 25） ng/L （P〈0. 01 ,〈0. 05,〈 0. 05） respectively. [Conclusion] TIPS is an effective method for HRS, which is related to blood content and rennin-angiotensin-Ⅱ-aldosterone system.