1型肝肾综合征的临床分析

Clinical analysis of type 1 hepatorenal syndrome

目的:探讨1型肝肾综合征(HRS)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2000-01/2008-08收治1型HRS住院患者29例,分析其基础疾病;病因;诱因;肝功能、肾功能及凝血像;Child-Pugh及终末期肝病模型(MELD)肝功能分级;尿量及生存率等.结果:1型HRS主要发生于晚期肝硬化和重症肝炎患者.Child-pugh评分均在B级以上,以C级为主(82.8%).B级与C级间血清总胆红素(TB),凝血酶原时间国际标准化比值(INR),血清白蛋白(ALB),MELD指标差异具有统计学意义(P<0.05).C级患者更易出现腹水、肝性脑病和感染.MELD评分20分以上27例(93.1%),多数在20～40分之间.不同MELD组间TB,INR,Cre,Child-pugh评分存在显著差异(P<0.05).MELD评分越高越易发生肝性脑病.29例患者随访1mo全部死亡.结论:1型HRS患者死亡率极高,应根据临床生化指标及肝功能分级综合判断其预后,做到早诊断,早治疗,以改善预后.

AIM： To analyze the causes, inducing factors and clinical indicators of type 1 hepatorenal syndrome （HRS） in hope of a better understanding of the disease. METHODS： In the review of 29 type 1 HRS patients treated in our hospital from January. 2000 to August. 2008, related data, inducing factors, TB, ALB, INR, Cre, Na ＋, Child-pugh, MELD scores, urine volume and survival rates, were collected and analyzed. RESULTS： Type 1 HRS mainly occurred in patients of late cirrhosis and severe hepatitis. Child-pugh scores were Level B and above, mainly Level C （82.76%）. TB, INR, ALB and MELD varied greatly between Level B and Level C （ P 〈 0.05 ）. Level C patients were more likely to suffer from ascites, hepatic encephalopathy and infection. Of the 29 patients, MELD scores of 27 patients （93.1% ） were above 20 points, mainly between 20 and 40 points, while TB, INR, Cre and Child-pugh scores varied greatly among groups of different MELD （ P 〈 0.05 ）. The higher a MELD score was, the more likely the patient was to have hepatic encephalopathy. All the 29 patients died within 1 month. CONCLUSION： The mortality rate of type 1 HRS patients is very high. A comprehensive prognosis can be judged by chnical characters, biochemical indicators and liver function classification. An improved prognosis can be expected when type 1 HRS patients are early diagnosed and treated.