特利加压素联合托伐普坦治疗乙型肝炎肝硬化并发肝肾综合征的疗效

Therapeutic effect analysis of terlipressin combined with torvaptan in the treatment of hepatitis B cirrhosis complicated hepatorenal syndrome

目的探讨特利加压素联合托伐普坦治疗乙型肝炎肝硬化并发肝肾综合征的效果。方法选择2016年1月至2019年12月住院的乙型肝炎肝硬化并发肝肾综合征患者60例,随机分为观察组和对照组各30例,两组患者均行抗病毒、抗纤维化、保肝等基础治疗,对照组给予呋塞米、螺内酯基础利尿剂治疗,观察组给予特利加压素联合托伐普坦治疗,疗程均为2周,观察两组患者治疗前后24 h尿量和血肌酐、尿素氮、胱抑素C、Na+水平以及门静脉主干内径和血流量变化。结果治疗前两组患者24 h尿量和血肌酐、尿素氮、胱抑素C、Na+浓度以及门静脉主干内径、血流量的变化不明显,差异均无统计学意义(P>0.05);治疗后观察组患者24 h尿量明显增加,血中的尿素氮、肌酐以及胱抑素C水平下降明显,血中Na+浓度明显升高,门静脉主干内径及血流量均明显降低,所有指标变化均显著优于对照组,差异有统计学意义(P<0.05)。结论特利加压素联合托伐普坦能有效改善乙型肝炎肝硬化并发肝肾综合征患者的肾功能,纠正低钠血症并降低门静脉压力。

Objective:To investigate the effect of terlipressin combined with torvaptan in the treatment of hepatitis B cirrhosis complicated hepatorenal syndrome.Methods:A total of 60 patients with hepatitis B cirrhosis complicated hepatorenal syndrome who were hospitalized from January 2016 to December 2019 were randomly divided into observation group and control group with 30 patients in each group.Patients in both groups were routinely treated with antiviral,anti-liver fibrosis and liver-protecting treatment,the control group was given furosemide and spironolactone based diuretic treatment,and the observation group was given terlipressin combined with torvaptam treatment,in a course of 2 weeks.24 h urine volume,serum creatinine,urea nitrogen,cystatin C,Na+levels,portal trunk diameter and blood flow were detected before and after treatment respectively in the two groups.Results:Before treatment,there was no statistical significance in 24 h urine volume,serum creatinine,urea nitrogen,cystatin C,Na+concentrations,portal trunk diameter and blood flow in 2 groups(P>0.05);After treatment,24 h urine volume in observation group was significantly increased,serum creatinine,urea nitrogen,cystatin C levels were significantly decreased,Na+concentration was significantly increased,portal trunk diameter and blood flow were significantly decreased,and all indexes were significantly better than those in control group(P<0.05).Conclusion:Terlipressin combined with tolvaptam can effectively improve renal function,correct hyponatremia and reduce portal pressure in patients with hepatitis B cirrhosis complicated hepatorenal syndrome.