去甲肾上腺素与特利加压素治疗肝肾综合征疗效比较

Efficacy Comparison Between Noradrenalin and Terlipressin in the Treatment of Hepatorenal Syndrome

目的:评估去甲肾上腺素(NE)治疗肝肾综合征(HRS)的疗效及安全性。方法:50例肝肾综合征患者随机分成3组,15例患者接受去甲肾上腺素[0.1-0.5μg/(kg·min)]加白蛋白(10g/d)治疗,15例患者接受特利加压素(0.5-1mg/4h)加白蛋白(10g/d)治疗,20例患者接受白蛋白(10g/d)治疗。治疗至肾功能逆转,最长疗程为15d。观察患者尿量、心率、平均动脉压、肝肾功能。结果:去甲肾上腺素组15例患者中8例患者肾功能好转(53.3%),特利加压素组15例患者中9例患者肾功能好转(60%),均未出现严重的心肌缺血,单纯白蛋白治疗组患者病情恶化。单变量分析显示,基线CTP(Child Tuecotte Pugh)积分、终末期肝病模型(MELD)、24h尿量、白蛋白、平均动脉压(MAP)与疗效相关。然而,多变量分析显示仅有CTP积分与疗效相关。结论:去甲肾上腺素治疗肝肾综合征具有和特利加压素相同的疗效和安全性,而费用显著降低。

Objective：To assess the efficacy and safety of noradrenalin vs terlipressin in patients with hepatorenal syndrome（HRS）.Methods：Fifty consecutive cirrhotic patients with HRS were included.Fifteen patients were treated with noradrenalin（0.1-0.5μg/[kg·min]）and albumin,fifteen patients were treated with terlipressin（0.5-1mg/4h）and albumin.Twenty patients only received albumin.Treatment was administered until HRS reversal or for a maximum of fifteen days.Results：Reversal of HRS was observed in 8of the 15patients（53.3%）treated with noradrenalin and in 9of the 15patients（60%）treated with terlipressin（P〈0.05）.Treatment of both groups showed an significant improvement in renal and circulatory function.No patient developed signs of myocardial ischemia.Conclusion：Noradrenalin is as effective and safe as terlipressin in patients with HRS.But it is a cheap and widely available drug in the management of these patients.