心肾综合征

Cardiorenal syndrome

心肾综合征特指在心力衰竭的治疗过程中,由于患者的肾功能出现明显下降,而导致心力衰竭治疗效果欠佳.目前,其诊断尚无统一标准,有学者将诊断标准确定为,在急性心力衰竭时血清肌酐升高3.0～5.0 mg/dl或者肾小球滤过率下降15 ml/min以上.心肾综合征确切发病率仍不清楚,但有研究显示,其在心力衰竭患者中的发病率可达30％左右.心肾综合征的病理生理机制比较复杂,中心静脉淤血、神经内分泌激活、贫血、氧化应激和肾交感神经过度激活可能是导致心肾综合征的重要原因.心肾综合征的治疗仍是一个很大的难题.原则上首先应纠正心肾综合征的可逆性诱因；其次,需要确定患者肾灌注状态,保证收缩压在80mmHg以上,平均压在60mmHg以上,对于低心排血量患者,可尝试使用硝酸酯类药物,降低心脏前后负荷；此外,还需及时停用影响肾功能的药物.具体讲,利尿剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、血液滤过、重组人B型利钠肽和加压素拮抗剂均可考虑应用.本文就心肾综合征的上述相关问题做一综述.

Cardiorenal syndrome（CRS） has been defined as a state in which therapy to relieve heart failure（HF） symptoms is limited by further worsening renal function. Currently, there is no widely accepted standard for the diagnosis of CRS syndrome. But some researchers have suggested that CRS can be diagnosed when renal function worsens with creatinine elevation 〉 3-5mg/L or glomeru- lar filtration rate decrement 〉 9-15 ml/min. Nowadays, the exact prevalence of CRS remains unclear. Some studies revealed that the incidence of CRS in case of HF reached as high as 30%. The mechanisms behind CRS are complex. Central venous congestion, neuroendocrine hyperactivity, anemia, oxidative stress and renal sympathetic nerve hyperactivity have been demonstrated to be important reasons causing cardiorenal syndrome. The treatment for CRS remains a big challenge. The first principle of the treatment is to correct the reversible risk factors. Stable renal perfusion is also needed by sustaining systolic blood pressure over 80mmHg or mean blood pressure over 60mmHg. For those with low cardiac output, nitrates might be helpful. Further, medications with renal toxicity should be withdrawn timely. Diuretics, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, hemofiltration, recombinant human B-type natriuretic peptide can be used as appropriate choice.