Ⅰ型肝肾综合征的临床分析

Clinical analysis of type I hepatorenal syndrome

目的探讨Ⅰ型肝肾综合征的发病原因、诱因及临床指标变化，以提高对该病的整体认知水平。方法回顾性查阅我院2000年至今收治的Ⅰ型HRS住院患者病例29例，分析其基础疾病及病因；发生肝肾综合征的诱因；肝肾功能及凝血象变化；CTP及MELD肝功能分级；尿量变化及生存率等。结果Ⅰ型HRS主要发生于晚期肝硬化和重症肝炎患者。易出现腹水、肝性脑病、感染及消化道出血等并发症。Child-Pugh评分多在B级和C级，以C级为主（82．76％）。MELD评分中有27例在20分以上（93．1％），多数位于20～40分之间。Child-Pugh评分B级和C级间的MELD评分存在显著性差异。其尿量逐渐减少，甚至无尿。29例患者中21例在住院期间死亡，8例自动出院。结论Ⅰ型HRS患者死亡率极高，应争取早发现、早诊断、早治疗，以改善预后。

Objective To analyze the clinical feature of type Ⅰ hepatorenal syndrome （HRS）. Methods We reviewed the clinical records of 29 type Ⅰ HRS patients who were diagnosed based on the International Ascites Club criteria. Serveral clinical factors of these patients were collected and analyzed to characterize the type Ⅰ HRS. Results Type Ⅰ HRS mainly occurred in the late cirrhosis and severe hepatitis patients. The patients of type Ⅰ HRS tended to appear ascites, hepatic encephalopathy, infection and gastroenterology bleeding. Child-Pugh scores were always in the B and C level, mainly C level （82.76%）. There had 27 cases （93.1%） whose MELD score was more than 20 points, mainly in 20 -40 points. There was a significant difference of MELD score between Child-Pugh B and C level. Urine of these patients gradually reduced, even anuria. Twenty-one patients were dead during hospitalization and eight patients were discharged by themselves. Conclusion The mortality of type Ⅰ HRS is very high. So these patients should be early found, early diagnosis, early treatment to improve the prognosis.