Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not bee...Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not been resolved. HRS encompasses 2 distinct types. Type 1 is characterized by the rapid development of renal failure that occurs within 2 wk and involves a doubling of initial serum creatinine. Type 2 has a more insidious onset and is often associated with ascites. Animal studies have shown that both forms, in particular type 1 HRS, are often precipitated by bacterial infections and cir-culatory changes. The prognosis for HRS remains very poor. Type 1 and 2 both have an expected survival time of 2 wk and 6 mo, respectively. Progression of liver cir-rhosis and the resultant portal hypertension leads to the pooling of blood in the splanchnic vascular bed. The ensuing hyperdynamic circulation causes an ineffective circulatory volume which subsequently activates neuro-hormonal systems. Primarily the sympathetic nervoussystem and the renin angiotensin system are activated, which, in the early stages of HRS, maintain adequate circulation. Both advanced cirrhosis and prolonged ac-tivation of neurohormonal mechanisms result in fatal complications. Locally produced nitric oxide may have the potential to induce a deleterious vasodilatory effect on the splanchnic circulation. Currently medical therapy is aimed at reducing splanchnic vasodilation to resolve the ineffective circulation and maintain good renal per-fusion pressure. Terlipressin, a vasopressin analogue, has shown potential benefit in the treatment of HRS. It prolongs both survival time and has the ability to re-verse HRS in the majority of patients. In this review we aim to focus on the pathogenesis of HRS and its treatment with terlipressin vs other drugs.展开更多
Terlipressin has been shown to improve both pulmonary and systemic hemodynamics in stable cirrhotic patients with pulmonary hypertension,whereas other vasoconstrictors may cause pulmonary pressures to deteriorate We i...Terlipressin has been shown to improve both pulmonary and systemic hemodynamics in stable cirrhotic patients with pulmonary hypertension,whereas other vasoconstrictors may cause pulmonary pressures to deteriorate We investigated the pulmonary and systemic hemodynamic effects of the first terlipressin dose(2 mg) in 7 cirrhotic patients with PH presenting with variceal bleeding(n=4) or hepatorenal syndrome(n=3).Terlipressin decreased pulmonary vascular resistance(158.8±8.9 vs 186.5±13.9 dynes sec cm-5 ;P=0.003) together with an increase in systemic vascular resistance(2143± 126 vs 1643±126 dynes sec cm-5 ;P<0.001).Terlipressin should be the vasoconstrictor treatment of choice when patients present with variceal bleeding or HRS.展开更多
BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of t...BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70%partial hepatectomy. METHODS: Seventy-two male Wistar rats were randomly assigned into three groups(n=24 in each group): 70% partial hepatectomy as control(PHC), 70% partial hepatectomy with splenectomy(PHS) or 70% partial hepatectomy with a micropump for terlipressin administration(PHT). Eight rats in each group were sacrificed on postoperative day(POD) 1,3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine(BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and 7.RESULTS: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups(PHT:8.13 ±1.55, 10.38±1.30, 6.25±0.89 cm H2O and PHS: 7.50±0.93,8.88 ±2.42, 5.75±1.04 cm H2O) was lower compared to the control group(PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1(Brd U: PHS vs PHC, 20.85% ±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96% ±11.69%). However, none of the differences were statistically significant.CONCLUSIONS: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of liver regeneration.展开更多
To the editor:We read with great interest the article entitled "Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats" by Ulmer et al.[1]...To the editor:We read with great interest the article entitled "Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats" by Ulmer et al.[1].The aim of this study was to analyse the impact of terlipressin ver-展开更多
To the Editor:Terlipressin is a long-acting synthetic analogue of vasopressin,demonstrating several potential benefits in the context of living donor liver transplantation(LDLT).During the recipient hepatec-tomy,terli...To the Editor:Terlipressin is a long-acting synthetic analogue of vasopressin,demonstrating several potential benefits in the context of living donor liver transplantation(LDLT).During the recipient hepatec-tomy,terlipressin reduces the portal flow.Consequently,it may mitigate the extent of bowel congestion following portal vein clamping.By decreasing portal hyperperfusion and hypertension,it protects the graft from further injury and improves renal blood flow.展开更多
Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjec...Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjects included 494 inpatient cases of hepatic failure who were treated in Department of Infectious Diseases,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China from 1997 to2008.Methods The patients that met the inclusion criteria were divided into intraperitoneal antibiotic injection group,intravenous terlipressin injection group,coloclysis group,plasma exchange group,combination group of coloclysis and plasma exchange in terms of treatment given and a control group was set up for each of the treatment group.In the intraperitoneal injection group,the prognosis and changes in clinical manifestations were observed in HF patients complicated with spontaneous peritonitis(SBP).In terlipressin injection group,HF patients complicated with hepatorenal syndrome(HRS) were observed for prognosis and changes in serum creatinine.In the combination group,the improvement in serum total bilirubin and prothrombin activity were observed.Results Two weeks after intraperitoneal injection of antibiotics,the ease ratios of abdominal pain,pressure pain and rebound tenderness were 87.64%,82.02%and 82.02%in the intraperitoneal injection group,respectively and the volume of ascites obviously decreased in 69 patients(77.53%).The survival rate in intraperitoneal injection group was significantly higher than in control group(P = 0.004).Four to eight days after the intravenous injection of terlipressin,the survival rate and the rate of serum creatinine decline of the treatment group were significantly higher than those in the control group(P = 0.003,P = 0.000).After 4 weeks of treatment,the ratio of clinical symptoms improvement(acratia,anorexia,abdominal distension,constipation) in coloclysis group were60.27%,57.53%,91.78%and 94.52%,in plasma exchange group were 71.83%,69.44%,75%and 72.22%,and in combination group were 82.14%,79.46%,92.85%and 95.54%.The serum total bilirubin was decreased and the prothrombin activity increased and the differences were statistically significant as compared with control group(P= 0.000).Conclusions The intraperitoneal injection of antibiotics,intravenous injection of terlipressin and combined treatment of coloclysis and plasma exchange were all effective for the treatment of HF and its complications.展开更多
目的系统评价特利加压素联合生长抑素治疗肝硬化上消化道出血的疗效及安全性。方法检索自建库至2023年7月在PubMed、Cochrane Library、Embase、Web of Science、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(...目的系统评价特利加压素联合生长抑素治疗肝硬化上消化道出血的疗效及安全性。方法检索自建库至2023年7月在PubMed、Cochrane Library、Embase、Web of Science、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(SinoMed)等发表的关于特利加压素联合生长抑素治疗肝硬化上消化道出血的随机对照试验(RCTs),试验组采用特利加压素联合生长抑素,对照组单用生长抑素。采用Revman5.3和Stata17软件对全因死亡率、总体有效率、不良事件发生率、止血时间、输血量和住院时间进行Meta分析。结果纳入20项RCTs,共计1502例患者。Meta分析结果显示:与对照组相比,试验组治疗肝硬化上消化道出血可降低全因死亡率(OR=0.34,95%CI:0.19~0.59,P<0.01)和输血量(SMD=-2.29,95%CI:-3.13~-1.46,P<0.01),缩短止血时间(SMD=-1.64,95%CI:-2.03~-1.25,P<0.01)和住院时间(MD=-7.12,95%CI:-7.47~-6.77,P<0.01),提高总体有效率(OR=3.50,95%CI:2.46~4.97,P<0.01);而不良事件的发生率比较差异无统计学意义(OR=1.20,95%CI:0.82~1.75,P=0.34)。结论现有证据表明,与单用生长抑素相比,特利加压素联合生长抑素治疗肝硬化上消化道出血可显著提高总体有效率,降低死亡风险和输血量,缩短止血时间及住院时间,且不增加不良反应。展开更多
目的:探究特利加压素联合去甲肾上腺素对脓毒症休克患者心肺损伤指标及微循环的影响。方法:选取2019年1月—2023年1月于恩施市中心医院重症医学科治疗的脓毒症休克患者80例,应用随机数字表法将其分为对照组及观察组,对照组(n=40)采用去...目的:探究特利加压素联合去甲肾上腺素对脓毒症休克患者心肺损伤指标及微循环的影响。方法:选取2019年1月—2023年1月于恩施市中心医院重症医学科治疗的脓毒症休克患者80例,应用随机数字表法将其分为对照组及观察组,对照组(n=40)采用去甲肾上腺素治疗,观察组(n=40)采用去甲肾上腺素联合特利加压素治疗。对比两组炎症因子[降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)],心肺损伤指标[肌酸激酶同工酶(CK-MB)、氧合指数(OI)、心肌肌钙蛋白(cTnI)、乳酸脱氢酶(LDH)、脑钠肽(BNP)],序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分、急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ),肝素结合蛋白(HBP),微循环指标[氧输送(DO_(2))、氧耗(VO_(2))、中心静脉氧饱和度(SvO_(2))],肠道功能指标[D-乳酸(D-Lac)、二胺氧化酶(DAO)、肠型脂肪酸结合蛋白(I-FABP)]。结果:治疗前,两组PCT、IL-6、CRP水平比较,差异均无统计学意义(P>0.05);治疗后,两组PCT、IL-6、CRP水平均较治疗前降低,且观察组均低于对照组(P<0.05)。治疗前,两组CK-MB、OI、cTnI、LDH、BNP水平比较,差异均无统计学意义(P>0.05);治疗后,两组OI水平均较治疗前升高、CK-MB、cTnI、LDH、BNP水平均较治疗前降低,观察组OI水平高于对照组,CK-MB、cTnI、LDH、BNP水平均低于对照组(P<0.05)。治疗前,两组SOFA评分、APACHEⅡ评分、HBP水平比较,差异均无统计学意义(P>0.05);治疗后,两组SOFA评分、APACHEⅡ评分、HBP水平均较治疗前降低,且观察组均低于对照组(P<0.05)。治疗前,两组DO_(2)、VO_(2)、Sv O_(2)水平比较,差异均无统计学意义(P>0.05);治疗12、24、36 h后两组DO_(2)、VO_(2)、SvO_(2)水平均较治疗前升高,且观察组均高于对照组(P<0.05)。治疗前,两组D-Lac、DAO、I-FABP水平比较,差异均无统计学意义(P>0.05);治疗12、24、36 h后两组D-Lac、DAO、I-FABP水平均较治疗前降低,且观察组均低于对照组(P<0.05)。结论:特利加压素联合去甲肾上腺素治疗脓毒症休克患者,可降低炎症因子及SOFA评分、APACHEⅡ评分,保护心肺器官,改善微循环及肠胃功能。展开更多
文摘Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not been resolved. HRS encompasses 2 distinct types. Type 1 is characterized by the rapid development of renal failure that occurs within 2 wk and involves a doubling of initial serum creatinine. Type 2 has a more insidious onset and is often associated with ascites. Animal studies have shown that both forms, in particular type 1 HRS, are often precipitated by bacterial infections and cir-culatory changes. The prognosis for HRS remains very poor. Type 1 and 2 both have an expected survival time of 2 wk and 6 mo, respectively. Progression of liver cir-rhosis and the resultant portal hypertension leads to the pooling of blood in the splanchnic vascular bed. The ensuing hyperdynamic circulation causes an ineffective circulatory volume which subsequently activates neuro-hormonal systems. Primarily the sympathetic nervoussystem and the renin angiotensin system are activated, which, in the early stages of HRS, maintain adequate circulation. Both advanced cirrhosis and prolonged ac-tivation of neurohormonal mechanisms result in fatal complications. Locally produced nitric oxide may have the potential to induce a deleterious vasodilatory effect on the splanchnic circulation. Currently medical therapy is aimed at reducing splanchnic vasodilation to resolve the ineffective circulation and maintain good renal per-fusion pressure. Terlipressin, a vasopressin analogue, has shown potential benefit in the treatment of HRS. It prolongs both survival time and has the ability to re-verse HRS in the majority of patients. In this review we aim to focus on the pathogenesis of HRS and its treatment with terlipressin vs other drugs.
文摘Terlipressin has been shown to improve both pulmonary and systemic hemodynamics in stable cirrhotic patients with pulmonary hypertension,whereas other vasoconstrictors may cause pulmonary pressures to deteriorate We investigated the pulmonary and systemic hemodynamic effects of the first terlipressin dose(2 mg) in 7 cirrhotic patients with PH presenting with variceal bleeding(n=4) or hepatorenal syndrome(n=3).Terlipressin decreased pulmonary vascular resistance(158.8±8.9 vs 186.5±13.9 dynes sec cm-5 ;P=0.003) together with an increase in systemic vascular resistance(2143± 126 vs 1643±126 dynes sec cm-5 ;P<0.001).Terlipressin should be the vasoconstrictor treatment of choice when patients present with variceal bleeding or HRS.
文摘BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70%partial hepatectomy. METHODS: Seventy-two male Wistar rats were randomly assigned into three groups(n=24 in each group): 70% partial hepatectomy as control(PHC), 70% partial hepatectomy with splenectomy(PHS) or 70% partial hepatectomy with a micropump for terlipressin administration(PHT). Eight rats in each group were sacrificed on postoperative day(POD) 1,3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine(BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and 7.RESULTS: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups(PHT:8.13 ±1.55, 10.38±1.30, 6.25±0.89 cm H2O and PHS: 7.50±0.93,8.88 ±2.42, 5.75±1.04 cm H2O) was lower compared to the control group(PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1(Brd U: PHS vs PHC, 20.85% ±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96% ±11.69%). However, none of the differences were statistically significant.CONCLUSIONS: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of liver regeneration.
文摘To the editor:We read with great interest the article entitled "Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats" by Ulmer et al.[1].The aim of this study was to analyse the impact of terlipressin ver-
文摘To the Editor:Terlipressin is a long-acting synthetic analogue of vasopressin,demonstrating several potential benefits in the context of living donor liver transplantation(LDLT).During the recipient hepatec-tomy,terlipressin reduces the portal flow.Consequently,it may mitigate the extent of bowel congestion following portal vein clamping.By decreasing portal hyperperfusion and hypertension,it protects the graft from further injury and improves renal blood flow.
文摘Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjects included 494 inpatient cases of hepatic failure who were treated in Department of Infectious Diseases,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China from 1997 to2008.Methods The patients that met the inclusion criteria were divided into intraperitoneal antibiotic injection group,intravenous terlipressin injection group,coloclysis group,plasma exchange group,combination group of coloclysis and plasma exchange in terms of treatment given and a control group was set up for each of the treatment group.In the intraperitoneal injection group,the prognosis and changes in clinical manifestations were observed in HF patients complicated with spontaneous peritonitis(SBP).In terlipressin injection group,HF patients complicated with hepatorenal syndrome(HRS) were observed for prognosis and changes in serum creatinine.In the combination group,the improvement in serum total bilirubin and prothrombin activity were observed.Results Two weeks after intraperitoneal injection of antibiotics,the ease ratios of abdominal pain,pressure pain and rebound tenderness were 87.64%,82.02%and 82.02%in the intraperitoneal injection group,respectively and the volume of ascites obviously decreased in 69 patients(77.53%).The survival rate in intraperitoneal injection group was significantly higher than in control group(P = 0.004).Four to eight days after the intravenous injection of terlipressin,the survival rate and the rate of serum creatinine decline of the treatment group were significantly higher than those in the control group(P = 0.003,P = 0.000).After 4 weeks of treatment,the ratio of clinical symptoms improvement(acratia,anorexia,abdominal distension,constipation) in coloclysis group were60.27%,57.53%,91.78%and 94.52%,in plasma exchange group were 71.83%,69.44%,75%and 72.22%,and in combination group were 82.14%,79.46%,92.85%and 95.54%.The serum total bilirubin was decreased and the prothrombin activity increased and the differences were statistically significant as compared with control group(P= 0.000).Conclusions The intraperitoneal injection of antibiotics,intravenous injection of terlipressin and combined treatment of coloclysis and plasma exchange were all effective for the treatment of HF and its complications.
文摘目的系统评价特利加压素联合生长抑素治疗肝硬化上消化道出血的疗效及安全性。方法检索自建库至2023年7月在PubMed、Cochrane Library、Embase、Web of Science、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(SinoMed)等发表的关于特利加压素联合生长抑素治疗肝硬化上消化道出血的随机对照试验(RCTs),试验组采用特利加压素联合生长抑素,对照组单用生长抑素。采用Revman5.3和Stata17软件对全因死亡率、总体有效率、不良事件发生率、止血时间、输血量和住院时间进行Meta分析。结果纳入20项RCTs,共计1502例患者。Meta分析结果显示:与对照组相比,试验组治疗肝硬化上消化道出血可降低全因死亡率(OR=0.34,95%CI:0.19~0.59,P<0.01)和输血量(SMD=-2.29,95%CI:-3.13~-1.46,P<0.01),缩短止血时间(SMD=-1.64,95%CI:-2.03~-1.25,P<0.01)和住院时间(MD=-7.12,95%CI:-7.47~-6.77,P<0.01),提高总体有效率(OR=3.50,95%CI:2.46~4.97,P<0.01);而不良事件的发生率比较差异无统计学意义(OR=1.20,95%CI:0.82~1.75,P=0.34)。结论现有证据表明,与单用生长抑素相比,特利加压素联合生长抑素治疗肝硬化上消化道出血可显著提高总体有效率,降低死亡风险和输血量,缩短止血时间及住院时间,且不增加不良反应。
文摘目的:探究特利加压素联合去甲肾上腺素对脓毒症休克患者心肺损伤指标及微循环的影响。方法:选取2019年1月—2023年1月于恩施市中心医院重症医学科治疗的脓毒症休克患者80例,应用随机数字表法将其分为对照组及观察组,对照组(n=40)采用去甲肾上腺素治疗,观察组(n=40)采用去甲肾上腺素联合特利加压素治疗。对比两组炎症因子[降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)],心肺损伤指标[肌酸激酶同工酶(CK-MB)、氧合指数(OI)、心肌肌钙蛋白(cTnI)、乳酸脱氢酶(LDH)、脑钠肽(BNP)],序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分、急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ),肝素结合蛋白(HBP),微循环指标[氧输送(DO_(2))、氧耗(VO_(2))、中心静脉氧饱和度(SvO_(2))],肠道功能指标[D-乳酸(D-Lac)、二胺氧化酶(DAO)、肠型脂肪酸结合蛋白(I-FABP)]。结果:治疗前,两组PCT、IL-6、CRP水平比较,差异均无统计学意义(P>0.05);治疗后,两组PCT、IL-6、CRP水平均较治疗前降低,且观察组均低于对照组(P<0.05)。治疗前,两组CK-MB、OI、cTnI、LDH、BNP水平比较,差异均无统计学意义(P>0.05);治疗后,两组OI水平均较治疗前升高、CK-MB、cTnI、LDH、BNP水平均较治疗前降低,观察组OI水平高于对照组,CK-MB、cTnI、LDH、BNP水平均低于对照组(P<0.05)。治疗前,两组SOFA评分、APACHEⅡ评分、HBP水平比较,差异均无统计学意义(P>0.05);治疗后,两组SOFA评分、APACHEⅡ评分、HBP水平均较治疗前降低,且观察组均低于对照组(P<0.05)。治疗前,两组DO_(2)、VO_(2)、Sv O_(2)水平比较,差异均无统计学意义(P>0.05);治疗12、24、36 h后两组DO_(2)、VO_(2)、SvO_(2)水平均较治疗前升高,且观察组均高于对照组(P<0.05)。治疗前,两组D-Lac、DAO、I-FABP水平比较,差异均无统计学意义(P>0.05);治疗12、24、36 h后两组D-Lac、DAO、I-FABP水平均较治疗前降低,且观察组均低于对照组(P<0.05)。结论:特利加压素联合去甲肾上腺素治疗脓毒症休克患者,可降低炎症因子及SOFA评分、APACHEⅡ评分,保护心肺器官,改善微循环及肠胃功能。
