特利加压素与去甲肾上腺素在肝肾综合征治疗中的比较

目的 比较去甲肾上腺素与特利加压索在肝肾综合征(HRS)治疗中的效果.方法 59例Ⅰ型HRS患者中,20例接受去甲肾上腺素治疗,6～16 mg/d,治疗至肾功能逆转,最多15 d；16例接受特利加压素治疗,0.5～2 mg/4h,治疗至肾功能逆转,最多15 d;23例为安慰剂治疗(对照组).所有患者均用白蛋白10 g/d治疗.观察患者治疗前后肝功能、肾功能、电解质、存活时间.统计学处理采用t检验和X2检验.结果 治疗15d后,20例接受去甲肾上腺素治疗的HRS患者,12例肾功能逆转(60％);16例接受特利加压素治疗患者,14例肾功能逆转(87.5％)；对照组23例病情较治疗前恶化；特利加压素组与其他两组比较,差异有统计学意义(P＜0.05).去甲肾上腺素组、特利加压素组和对照组的综合应答率分别为80％、100％和17.4％,差异有统计学意义(P＜0.05).结论 特利加压素、去甲肾上腺素是治疗HRS的有效药物,特利加压素疗效更佳,两者远期疗效尚不确定.

Comparison between terlipressin and noradrenaline in the treatment of hepatorenal syndrome

Objective To evaluate the efficacy and safety of terlipressin compared with noradrenaline in the treatment of hepatorenal syndrome.Methods Among the fifty-nine consecutive cirrhotic patients with type I hepatorenal syndrome,20 patients received noradrenaline 6-16 mg/d to improve renal function;16 patients were assigned with the treatment of terlipressin 0.5-2 mg/4 h to improve renal function;23 cases received the placebo.All the patients were given albumin(10 g/d).The treatment was administered until HRS reversal or for maximum 2 weeks.All the patients serum chemical index of liver and renal function were detected before treatment,at the first day,fifteenth day, thirtieth day,sixtieth day and ninetieth day after the treatment.Results At the end of the study,reversal of HRS was observed in 12 of the 20 patients(60%) treated with noradrenaline and in 14 of the 16 patients(87.5%) treated with terlipressin.Noradrenaline or terlipressin treatment led to a significant improvement in renal function;but the aggravation of liver and renal function was observed in the placebo group.Compared with other two groups,the rate of response to terlipressin had difference statistically(P<0.05).The rates of combined response to noradrenaline and terlipressin and conserved treatment were 80%,100%and 17.4%,respectively.All these rates had significantly statistical differences(P<0.05).Conclusion Noradrenaline and terlipressin are effective in the management of HRS. The efficacy of terlipressin is better than that of noradrenaline.Their long-term efficacy is undefined.