肝肾综合征的发病机制和治疗的进展

肝肾综合征(HRS)是严重肝病常见并发症,病死率极高。临床表现为功能性肾衰竭。其发病机制非常复杂,主要有外周动脉扩张学说和肝肾直接相关学说。治疗主要是针对循环动力学改变及肾灌注不足等环节选择具有较强的全身血管收缩作用,对肾动脉无影响的血管活性药,加上血浆扩张剂,以逆转高动力循环状态,抑制RAAS和交感神经系统的兴奋,改善肾功能;针对门静脉高压环节给予经颈静脉肝内门_体分流(TIPS)治疗;最佳治疗是肝移植。HRS应采取积极预防措施。

The developments of pathogenesis and treatment in hepatorenal syndrome

Hepatorenal syndrome (HRS) is a common complication of serious liver disease with a very high mortality. Functional renal failure is its major clinical manifestation. The pathogenesis of HRS is very complicated, such as peripheral arteries vasodilation theory and hepato-renal reflex theory. Treatment includes: vasocontractive Drugs, that are highly selective to systemic vasocontraction with a minimal effect on renal blood flow, should be used in combination with the plasma expansion, in order to correct the hyperdynamic circulation, to inhibit the stimulation of RAAS and the sympathetic nerve, and to improve the renal function; Transjugular intrahepatic portosystemic shunt (TIPS) should be used to reduce portal hypertension; and Liver transplantation should be the best treatment for HRS. Due to less effect of the treatment, prevention of HRS is the best way for progressing to HRS.