肝肾综合征诊疗进展

Progress in the treatment of hepatorenal syndrome

肝肾综合征(HRS)是慢性肝病进展性衰竭、晚期肝硬化门脉高压患者常见的并发症之一。其发病机制尚不明确。临床表现为功能性肾衰竭,并根据肾衰竭进展速度分为HRSⅠ型和HRSⅡ型,国际腹水协会于2007年重新修订HRS诊断标准。治疗上,改善肾功能、延长生存期仍是目前治疗的重点。最有效的方法是活体肝移植(OLT),但因费用昂贵及肝源有限,且HRS的生存时间短,因此需延缓患者生存时间为OLT治疗争取机会,而血管收缩药物联合静脉输注蛋、经颈静脉肝内门体分流术(TIPS)、分子吸附再循环系统(MARS)可作为HRS过渡至OLT治疗的桥梁治疗。

Hepatorenal syndrome（HRS）is one of the most common complications in patients with progressive renal failure of chronic liver diseases and portal hypertension caused by advanced cirrhosis.Its pathogenesis is still unclear.According to the diagnostic criteria revised by International Club of Ascites in 2007,there are two types of HRS classified by renal failure progress,HRS I and HRS II.The treatments of HRS are focused on improving renal function and prolonging life span.Living donor liver transplantation（LDLT）is the most effective treatment.However its drawbacks include huge cost,lack of liver source and short survival time.In order to gain the precious time for HRS patients before LDLT,vasoconstriction drug combined by protein IV infusion therapy,Transjugular intrahepatic portosystemic stent-shunt（TIPS）and Moleculular Adsorbent Recirculating System（MARS）could be the transition treatment.