背景:特利加压素与白蛋白一起推荐用于肝肾综合征(HRS)。特利加压素是昂贵的并且在许多国家没有许可。替代疗法是必要的。我们比较了特利加压素和白蛋白与同时服用低剂量多巴胺的疗效,呋塞米,和HRS中的白蛋白。
方法:在开放标签中,随机试验,连续40例I型HRS和II型HRS患者,每6小时同时输注特利加压素0.5mg和白蛋白20g/天,共5天(n=20)或多巴胺2μg/kg/min的组合,呋塞米0.01mg/kg/hr,和白蛋白20克/天(三联疗法),在两个治疗臂中的一个。24小时尿量,尿钠,治疗前后分别评估血浆肾素活性(PRA)。
结果:两组在基线时HRS-I和II具有可比性。在HRS-I中,两个治疗组的24小时尿量和5天结束时的尿钠增加(特利加压素,尿量278±136至765±699ml/天,P<0.01;尿钠28±25.1至39±32.1meq/l,P=0.05。三联疗法:尿量219±134至706±595毫升/天,P<0.01;尿钠25±18.3至41±27.5meq/l,P<0.01)。特利加压素和三联疗法组的PRA(ng/ml/hr)从28.1±9.76降至24.2±9.5(P=0.01),从29.5±15.8降至27.3±17.1(P=0.02),分别。在HRS-II中,在24小时尿量和尿钠方面观察到类似的显着改善(P<0.01);两组治疗后PRA均降低(P<0.05)。治疗后的参数变化在两组之间具有可比性,在HRS-I和HRS-II病例中。
结论:同时三联疗法改善了HRS的肾功能,并且比特利加压素便宜(注册:CTRI/2011/07/001860;www。ctri.nic.in).
BACKGROUND: Terlipressin with albumin is recommended in hepatorenal syndrome (HRS). Terlipressin is expensive and not licensed in many countries. Alternative therapy is necessary. We compared the efficacy of terlipressin and albumin with concurrent low-dose dopamine, furosemide, and albumin in HRS.
METHODS: In an open-label, randomized
trial, forty consecutive patients each with HRS type I and HRS type II received either concurrent infusion of terlipressin 0.5 mg for every 6 hr and albumin 20 g/day for 5 days (n = 20) or a combination of dopamine 2 μg/kg/min, furosemide 0.01 mg/kg/hr, and albumin 20 g/day (triple therapy), in one of two therapeutic arms. Twenty-four-hour urine output, urinary sodium, and plasma renin activity (
PRA) were assessed before and after treatment.
RESULTS: The two groups were comparable at baseline in both HRS-I and II. In HRS-I, 24 hr urine output and urine sodium at the end of 5 days increased in both treatment groups (terlipressin, urine output 278 ± 136 to 765 ± 699 ml/day, P < 0.01; urine sodium 28 ± 25.1 to 39 ± 32.1 meq/l, P = 0.05. Triple therapy: urine output 219 ± 134 to 706 ± 595 ml/day, P < 0.01; urine sodium 25 ± 18.3 to 41 ± 27.5 meq/l, P < 0.01).
PRA (ng/ml/hr) decreased from 28.1 ± 9.76 to 24.2 ± 9.5 (P = 0.01) and from 29.5 ± 15.8 to 27.3 ± 17.1 (P = 0.02) in the terlipressin and triple therapy groups, respectively. In HRS-II, similar significant improvement (P < 0.01) was seen in 24 hr urine output and urine sodium; decrease in
PRA (P < 0.05) was documented after treatment in both the arms. Post-treatment changes in parameters were comparable between the two arms, in both HRS-I and HRS-II cases.
CONCLUSIONS: Concurrent triple therapy improved renal function in HRS and was less expensive than terlipressin (Registration: CTRI/2011/07/001860; www.ctri.nic.in).