奥曲肽注射液联合前列地尔注射液在常规治疗肝硬化合并HES患者中的作用

Therapeutic effects of octreotide combined with alprostadil on cirrhosis with hepatorenal syndrome

目的:探讨奥曲肽联合前列地尔治疗肝硬化并肝肾综合征(hepatorenal syndrome,HRS)的临床疗效.方法:按照随机数字表法将我院消化内科收治的60例肝硬化合并HRS患者均分为试验组和对照组,两组患者均给予常规综合治疗,试验组患者加用奥曲肽注射液联合前列地尔注射液治疗,对照组患者加用前列地尔注射液治疗,比较两组患者治疗前后肾功能指标、血流动力学水平、门静脉内径和脾静脉内径变化情况以及临床疗效.结果:试验组患者治疗后尿素氮(blood urea nitrogen,BUN)和血肌酐(serum creatinine,S C r)水平明显降低,24 h尿量明显增加,与治疗前比较(10.15 mmol/L±5.02 mmol/L vs19.02 mmol/L±7.45 mmol/L、136.13μmol/L±18.62μmol/L vs 211.42μmol/L±17.66μmol/L、1644.36 mL/d±178.30 mL/d,vs443.41 mL/d±77.88 mL/d)差异具有统计学意义(P<0.05);对照组患者治疗后SCr水平明显降低,24 h尿量明显增加,与治疗前比较(152.60μmol/L±16.89μmol/L vs 207.12μmol/L±16.27μmol/L)、(1207.26 mL/d±177.05 mL/d vs 459.51 mL/d±90.37 mL/d),差异具有统计学意义(P<0.05);试验组患者治疗后BUN和SCr水平明显低于对照组(10.15mmol/L±5.02 mmol/L vs 15.72 mmol/L±7.71mmol/L)、(136.13μmol/L±18.62μmol/L vs152.60μmol/L±16.89μmol/L),24 h尿量明显高于对照组,(1644.36 mL/d±178.30 mL/d,vs 1207.26 mL/d±177.05 mL/d)差异具有统计学意义(P<0.05);两组患者治疗前后平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)水平无明显变化(78.45 mmHg±4.01mmHg vs 76.44 mmHg±4.06 mmHg)、(84.08次/min±4.70次/min vs 86.22次/min±4.67次/min),(78.53 mmHg±4.17 mmHg vs 78.22mmHg±4.08 mmHg)、(84.77次/min±4.34次/min vs 85.55次/min±4.58次/min),差异无统计学意义(P>0.05);两组患者治疗后门静脉内径和脾静脉内径均明显降低,与治疗前比较(11.99 mm±1.33 mm vs 14.02 mm±1.37mm)、(8.16 mm±1.20 mm vs 10.65 mm±1.57mm),(13.05 mm±1.16 mm vs 13.94 mm±1.27mm)、(9.36 mm±1.61 mm vs 10.50 mm±1.61mm),差异具有统计学意义(P<0.05);试验组患者治疗后门静脉内径和脾静脉内径均明显低于对照组(11.99 mm±1.33 mm vs 13.05 mm±1.16 mm)、(8.16 mm±1.20 mm vs 9.36 mm±1.61 mm),差异具有统计学意义(P<0.05);试验组患者显效率和总有效率均明显高于对照组(20.00%vs 6.67%、83.33%vs 46.67%),差异具有统计学意义(P<0.05);两组患者死亡率比较(6.67%vs 6.67%),差异无统计学意义(P>0.05).结论:奥曲肽联合前列地尔能够有效改善肝硬化并HRS患者肾功能、降低门静脉的压力,对患者血流动力学影响小、安全性高,是临床治疗的首选.

AIM： To explore the therapeutic effects of octreotide combined with alprostadil on cirrhosis with hepatorenal syndrome.METHODS： Sixty patients with cirrhosis and hepatorenal syndrome were randomly divided into two groups： a control group and an experimental group. The control group was treated by conventional treatment, while the experimental group was additionally given octreotide combined with alprostadil on the basis of conventional treatment. The indexes of renal function, hemodynamic parameters, diameters of the portal vein and splenic vein, and clinical effects were compared.RESULTS： In the experiment group, the levelsof BUN and SCr were significantly lower（10.15 mmol/L ± 5.02 mmol/L vs 19.02 mmol/L ± 7.45 mmol/L, 136.13 μmol/L ± 18.62 μmol/L vs 211.42 μmol/L ± 17.66 μmol/L, P 0.05） and the level of 24 h urine volume was significantly higher（1644.36 mL/d ± 178.30 mL/d vs 443.41 mL/d ± 77.88mL/d, P 0.05） after treatment than before treatment. In the control group, the level of SCr was significantly lower（152.60 μmol/L ± 16.89 μmol/L vs 207.12 μmol/L ± 16.27 μmol/L, P 0.05） and the level of 24 h urine volume was significantly higher（1207.26 mL/d ± 177.05 mL/d vs 459.51 mL/d ± 90.37mL/d, P 0.05） after treatment than before treatment. The levels of BUN and SCr were significantly lower（10.15 mmol/L ± 5.02 mmol/L vs 15.72 mmol/L ± 7.71 mmol/L, 136.13 μmol/L ± 18.62 μmol/L vs 152.60 μmol/L ± 16.89 μmol/L, P 0.05） and the level of 24 h urine volume was significantly higher（1644.36 mL/d ± 178.30 mL/d vs 1207.26 mL/d ± 177.05 mL/d, P 0.05） in the experimental group than in the control group. There were no significant differences in the levels of MAP and HR between before and after treatment in both groups（78.45 mmHg ± 4.01 mmHg vs 76.44 mmHg ± 4.06 mmHg, 84.08/min ± 4.70/min vs 86.22/min ± 4.67/min, 78.53 mmHg ± 4.17 mmHg vs 78.22 mmHg ± 4.08 mmHg, 84.77/min ± 4.34/min vs 85.55/min ± 4.58/min, P 0.05）. The diameters of the portal vein and splenic vein were significantly lower（11.99 mm ± 1.33 mm vs 14.02 mm ± 1.37 mm, 8.16 mm ± 1.20 mm vs 10.65 mm ± 1.57 mm, 13.05 mm ± 1.16 mm vs 13.94 mm ± 1.27 mm, 9.36 mm ± 1.61 mm vs 10.50 mm ± 1.61 mm, P 0.05） after treatment than before treatment in both groups. The diameters of the portal vein and splenic vein in the experiment group were significantly lower than those in the control group（11.99 mm ± 1.33 mm vs 13.05 mm ± 1.16 mm, 8.16 mm ± 1.20 mm vs 9.36 mm ± 1.61 mm, P〈 0.05）. The improvement rate and the total response rate in the experimental group were significantly higher than those in the control group（20.00% vs 6.67%, 83.33% vs 46.67%, P 〈0.05）, although there was no significant difference in mortality（6.67% vs 6.67%, P 〉0.05）.CONCLUSION： Octreotide combined with alprostadil can improve renal function, reduce the portal pressure, has less impact on haemodynamics and high safety in patients with cirrhosis with hepatorenal syndrome.