肝硬化患者急性肾损伤的诊断与治疗

Diagnosis and treatment of acute kidney injury in patients with cirrhosis

急性肾损伤(AKI)是肝硬化患者的一种常见并发症,以肾小球滤过率突然下降,代谢废物潴留、水电解质失调、酸碱平衡紊乱为特点。AKI显著增加肝硬化患者病死率。其早期诊断和治疗对降低病死率、改善预后至关重要。简述了AKI诊断标准的演进,肾功能损伤新型标志物如胱抑素C、肾损伤分子1、中性粒细胞明胶酶相关性脂质运载蛋白的应用情况以及肝硬化AKI的治疗手段。尽管血肌酐和尿量有诸多缺点,但仍是AKI诊断的主要标准。寻找具有临床应用价值的新型标志物将成为研究的热点,未来仍须在肝硬化AKI的基础和临床方面努力专研,以寻求新的突破。

Acute kidney injury is a common complication in patients with cirrhosis.It is characterized by a sudden drop in glomerular filtra-tion rate,retention of metabolic waste products,water-electrolyte imbalance,and acid-base disturbance.It markedly increases mortality in cirrhotic patients.Therefore,early diagnosis and treatment of acute kidney injury are essential to reduce mortality and improve prognosis. The development of the diagnostic criteria for acute kidney injury,the clinical application of new biomarkers of renal function such as cystatin C,kidney injury molecule-1 ,and neutrophil gelatinase-associated lipocalin,and the management of acute kidney injury in cirrhotic pa-tients are reviewed.Although creatinine test and monitoring of urinary output have their disadvantages,they remain the main diagnostic crite-ria for acute kidney injury.Development of new biomarkers for clinical use and elucidation of the underlying mechanisms of acute kidney in-jury have become a hotspot of basic and clinical research.