Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome:: A randomized study
Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome:: A randomized study
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DOI：
10.1053/j.gastro.2008.02.024
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发表时间：
2008-05-01
期刊：
影响因子：
29.4
通讯作者：
Gines, Pere
中科院分区：
文献类型：
--
作者：
Martin-Llahi, Marta;Pepin, Marie-Noelle;Gines, Pere
背景与目的：肝肾综合征在晚期肝硬化患者中很常见，是肝移植中的一个主要问题。肝肾综合征没有有效的药物治疗。研究方法：在三级护理中心住院的46例肝硬化和肝肾综合征患者被随机分配接受特利加压素（1-2 mg/4小时，静脉注射）、血管加压素类似物和白蛋白（1 g/kg，随后20-40 g/天）（n = 23）或单用白蛋白（n = 23），最多持续15天。主要结局是肾功能改善和3个月生存率。结果如下：特利加压素和白蛋白联合治疗组中有10例患者（43.5%）肾功能改善，而单用白蛋白治疗组中有2例患者（8.7%）肾功能改善（P = 0.017）。肾功能改善的独立预测因素是基线尿量、血清肌酐和白细胞计数以及特利加压素和白蛋白治疗。两组间3个月生存率无显著差异（特利加压素和白蛋白：27% vs白蛋白19%，P = 0.7）。3个月生存率的独立预测因素是终末期肝病评分的基线模型和肾功能的改善。4例单独接受白蛋白治疗的患者和10例接受特利加压素和白蛋白治疗的患者发生心血管并发症，但仅3例病例需要永久停用特利加压素。结论：与白蛋白相比，特利加压素和白蛋白治疗可有效改善肝硬化和肝肾综合征患者的肾功能。应进行更大样本量的进一步研究，以测试肾功能的改善是否转化为生存获益。
Background & Aims: Hepatorenal syndrome is common in patients with advanced cirrhosis and constitutes a major problem in liver transplantation. There is no effective medical treatment for hepatorenal syndrome. Methods: Forty-six patients with cirrhosis and hepatorenal syndrome, hospitalized in a tertiary care center, were randomly assigned to receive either terlipressin (1-2 mg/4 hour, intravenously), a vasopressin analogue, and albumin (1 g/kg followed by 20-40 g/day) (n = 23) or albumin alone (n = 23) for a maximum of 15 days. Primary outcomes were improvement of renal function and survival at 3 months. Results: Improvement of renal function occurred in 10 patients (43.5%) treated with terlipressin and albumin compared with 2 patients (8.7%) treated with albumin alone (P = .017). Independent predictive factors of improvement of renal function were baseline urine volume, serum creatinine and leukocyte count, and treatment with terlipressin and albumin. Survival at 3 months was not significantly different between the 2 groups (terlipressin and albumin: 27% vs albumin 19%, P = .7). Independent predictive factors of 3-month survival were baseline model for end-stage liver disease score and improvement of renal function. Cardiovascular complications occurred in 4 patients treated with albumin alone and in 10 patients treated with terlipressin and albumin, yet permanent terlipressin withdrawal was required in only 3 cases. Conclusions: As compared with albumin, treatment with terlipressin and albumin is effective in improving renal function in patients with cirrhosis and hepatorenal syndrome. Further studies with large sample sizes should be performed to test whether the improvement of renal function translates into a survival benefit.