肝肾综合征新进展课件【荐】.pdfVIP

肝肾综合征 特利加压素治疗及评价 上海交通大学瑞金医院 吴云林 肝肾综合征 （Hepatorenal Syndrome，HRS） 重症肝病患者发生一种严重并发症。 功能性肾功能受损 肾小球滤过率降低 显著心血管功能异常内源血管活性系统过度 活跃 少尿无尿氮质血症低血钠低尿钠等 Pathogenesis of Circulatory Abnormalities and Renal Failure in Cirrhosis N Engl J Med 2009;361:1279-90 Pathophysiology of Hepatorenal Syndrome Wong, et al. Liver ,2008,10:22-29 Pathophysiology of Hepatorenal Syndrome Renal abnormalities 肾脏异常 - Marked renal vasoconstriction 肾血管强烈收缩 - Marked reduction of GFR 肾小球滤过率明显降低 - Impaired sodium and water excretion 钠水排泄损伤 Circulatory abnormalities 循环异常 - Arterial hypotension. Low systemic vascular resistance 动脉性低血压 全身血管阻力降低 - Normal/reduced cardiac output 心输出量正常/降低 - Marked activation of vasoconstrictor systems 血管收缩系统明显激活 Clinical Types of Hepatorenal Syndrome 肝肾综合征的临床分型 Type I rapidly progressive reduction in renal function as defined by a doubling of the initial serum creatinine to a level 2.5 mg/dL or a 50% reduction of the initial 24-hour creatinine clearance to a level 20 mL/minute in less than 2 weeks. Type II does not have a rapidly progressive course and is a common cause of death in patients who do not die of other complications of cirrhosis. Salerno F et al, international ascites club. Gut 2007;56:1310-1318 Clinical Features of type I HRS 1、rapidly progressive renal failure serum creatinine ：doubling of the initial level / greater than 226 μmol/L (2.5 mg/dL) in less