急性心肾综合征的研究进展

Research progress of acute cardiorenal syndrome

心肾功能损害是临床最常见的疾病,两者相互影响,互为因果,可导致一系列临床症状,即心肾综合征(CRS).2008年,肾病学家Ronco等根据心脏和肾脏之间的联系,对CRS进行了完整的定义和分型,Ⅰ型为急性心肾综合征(ACRS),Ⅲ型为急性肾心综合征(ARCS).ACRS是指心脏或肾脏功能不全时相互影响而导致心肾功能急剧恶化的临床综合征,目前ACRS尚无明确的诊断标准.ACRS的发病机制可能与肾素-血管紧张素-醛固酮系统(RAAS)、一氧化氮-活性氧簇(NO-ROS)系统、炎症反应、交感神经系统的过度激活等有关.临床上约有50%的ACRS患者伴有急性失代偿性心肾功能障碍或衰竭,严重影响了患者临床预后和生存率,因此有必要寻找一种有效的治疗方案,目前ACRS的治疗主要有利尿剂、血管紧张素转化酶抑制剂(ACEI)、血管紧张素受体抑制剂(ARB)、β-受体阻滞剂、正性肌力药物、重组人红细胞生成素、重组人脑利钠肽、连续性血液净化(CBP)等,中医药对改善ACRS患者临床症状也有一定疗效.现就ACRS的发病机制、诊断及中西医结合治疗方法进行综述.

The heart and kidney damage is a clinical disease commonly seen, the 2 organs can interact with each other as cause and effect, leading to a series of clinical symptoms which is the cardiorenal syndrome (CRS). In 2008, according to the connection between the heart and kidney, the nephrologists Ronco, etc, completed the definition and classification of CRS, including type Ⅰ and type Ⅲ of CRS being acute cardiorenal syndrome (ACRS). ACRS refers to the fact that when the damage of heart or kidney dysfunction influences each other leading to a clinical syndrome caused by a sharp deterioration of cardiorenal function. At present, no definite diagnostic criteria for ACRS have yet been made. The pathogenesis of ACRS may be related to the renin-angiotensin-aldosterone system (RAAS), nitric oxide-reactive oxygen species (NO-ROS) system, inflammatory reaction, the excessive activation of sympathetic nervous system and so on. Clinically, about 50% of ACRS patients are accompanied by acute decompensated cardiorenal dysfunction or failure, that seriously impact on the patients' clinical prognosis and survival rate, so it is necessary to find an effective therapeutic regimen. At present, the treatments of ACRS have mainly the diuretic, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor inhibitor (ARB), β-receptor blocker, positive inotropic drugs, recombinant human erythropoietin, recombinant human brain natriuretic peptide, continuous blood purification (CBP) etc, and traditional Chinese medicine (TCM) also has a certain effect for improving the clinical symptoms of ACRS patients. Now the pathogenesis, diagnosis, and combined treatment of TCM and western medicine for treatment of ACRS are summarized.