肝肾综合征72例临床特征分析

Clinical characteristic analysis of 72 patients with hepatorenal syndrome

目的探讨肝肾综合征（HRS）患者的临床特点，指导临床对HRS进行有效地预防和治疗。方法回顾性分析72例HRS患者的临床资料，比较HRS发生前后血清钠（Na＋）、肌酐（Cr）、白蛋白（ALB）和凝血酶原活动度（PrrA）的变化情况。结果HRS多发于40～59岁男性，主要发生于乙型肝炎所致的肝硬化，肝功能绝大多数处于Child—PughC级，病死率高。大量腹水、继发感染、上消化道出血、大量放腹水可诱发HRS。HRS发生前后患者血清Na＋、Cr、ALB和胛A的变化显著（P〈0．05）。结论HRS患者的病情重，病死率高，预后差，要重视对肝肾综合征的临床研究。HRS患者肝功能差，血清Na＋、ALB和PTA降低，血清Cr升高，常见诱因为大量腹水、继发感染、上消化道出血、大量放腹水，应尽量避免，发现后应积极治疗。

Objective To investigate the clinical features of hepatorenal syndrome （RSH）, and to guide the effective prevention and treatment of the disease. Methods The clinical data of 72 patients with RSH were retrospectively analyzed, the changes of serum sodium, creatinine（Cr）, albumin（ALB） and prothrombin activity（PTA） were compared before and after the occurrence of RSH. Results HRS was more prevalent among males aged 40 -59 and patients with cirrhosis caused by hepatitis B, the vast majority of liver function in a Child-Pugh C level, and with high mortality. Massive ascites, secondary in- fection, upper gastrointestinal bleeding and releasing a large number of ascites could induce the occur- rence of HRS. The serum sodium, Cr, ALB and FFA changed significantly before and after the occur- rence of RSH （P 〈 0.05 ）. Conclusions Patients with HSR have serious conditions, high mortality and the prognosis is poor, so we should pay attention to the clinical research of HSR. The patients with HRS have poor liver function, reduced serum sodium, ALB and PTA, increased serum Cr. The common pre- disposing factor of HRS including massive ascites, secondary infection, upper gastrointestinal bleeding and releasing a large number of ascites, we should avoid these factors as far as possible, once happened we should take active treatment.