■1型肝肾综合征(HRS)是肝硬化患者的肾功能迅速恶化。关于血管收缩剂对1型HRS的功效的数据显示出混合的结果。
■文献搜索比较药物治疗HRS与安慰剂或其他药物治疗HRS的随机对照试验。主要结果是HRS逆转(血清肌酐<1.5mg/dL,2个读数),次要结局为无肝移植(LT)生存率和严重不良事件(SAE).
■对1244名患者进行的16项研究(平均年龄50.3岁。,67.5%男性,血清肌酐为3.07mg/dL,血清钠127.2mEq/L,和终末期肝病模型(MELD)评分为30.9,Child-Pugh评分为11)与血管收缩剂治疗的1型HRS与安慰剂或其他药物进行了分析。所有患者均接受静脉白蛋白输注。(A)特利加压素与安慰剂:使用特利加压素的HRS逆转的赔率是3.3倍,对无LT患者的存活没有差异。特利加压素与较高的SAE几率相关。(B)Nor-肾上腺素(NE)与特利加压素:HRS逆转无差异,无LT生存,和SAE。(C)特利加压素或NE与米多君和奥曲肽:用米多君和奥曲肽逆转HRS的几率降低91%。SAE没有差异(64个中的10个与58个中的10个,P=0.812)。非响应者与响应者的平均MELD得分较高(29vs27.8),P=.014和血清肌酐(3.5vs3.1),P=.027。
■特利加压素和NE在HRS逆转方面相似且优于米多君奥曲肽组合。无治疗可改善无LT患者的生存率。较低的基线血清肌酐和MELD评分对治疗的反应更好。特利加压素和NE的不良反应风险相似。需要研究作为基础,以确定对具有良好安全性的治疗反应的候选人。
UNASSIGNED: Type 1 hepatorenal syndrome (HRS) is a rapid deterioration in kidney function in patients with cirrhosis. Data on efficacy of vasoconstrictors for type 1 HRS have shown mixed results.
UNASSIGNED: Literature searched for randomized controlled trials comparing pharmacological therapy for HRS vs placebo or another drug for HRS. Primary outcome was HRS reversal (serum creatinine <1.5mg/dL on 2 readings), and secondary outcomes were liver transplant (LT) free survival and serious adverse events (SAE).
UNASSIGNED: Sixteen studies on 1244 patients (mean age 50.3 yrs., 67.5% males, serum creatinine of 3.07 mg/dL, serum sodium 127.2 mEq/liter, and Model for End-stage Liver Disease (MELD) score of 30.9, and Child-Pugh score 11) with type 1 HRS treated with vasoconstrictors vs placebo or another drug were analyzed. All the patients received intravenous albumin infusion. (A)
terlipressin vs placebo: Odds of HRS reversal were 3.3 folds with
terlipressin without difference on LT-free patient survival.
Terlipressin was associated with higher odds of SAE. (B) Nor-epinephrine (NE) vs
terlipressin: No difference on HRS reversal, LT-free survival, and SAE. (C)
Terlipressin or NE vs midodrine and octreotide: 91% lower odds of HRS reversal with midodrine and octreotide. There were no differences on SAE (10 of 64 vs 10 of 58, P = .812). Non-responders vs responders had higher mean MELD score (29 vs 27.8), P = .014 and serum creatinine (3.5 vs 3.1), P = .027.
UNASSIGNED: Terlipressin and NE are similar and superior to midodrine octreotide combination for HRS reversal. No therapy improves LT-free patient survival. Response to treatment is better with lower baseline serum creatinine and MELD score. The risk of adverse effects is similar with
terlipressin and NE. Studies are needed as basis to identify candidates with best response to treatment with excellent safety profile.