CAJ | 학술논문

目的：观察国产特利加压素治疗Ⅱ型肝肾综合征（HRS）的疗效。方法选取2011年11月－2014年6月上海市浦东新区南华医院收治的25例Ⅱ型 HRS 患者作为治疗组，2011年前用多巴胺治疗的28例Ⅱ型 HRS 患者作为对照组。治疗组随机分成两组，其中一组（12例）每8 h 给药1次，另一组（13例）每12 h 给药1次。两组给药前均予以白蛋白（Alb）扩容，疗程均为7 d。观察两组患者治疗前后症状改善情况，尿素氮、血清肌酐、电解质、尿量、肝功能变化及腹水消退情况。计数资料组间比较采用χ2检验，计量资料组间比较采用 t 检验。结果对照组患者症状改善不明显，治疗组患者症状均得到不同程度的改善。两组患者治疗前后肝功能、血清钠均无明显变化。治疗组患者腹水从大量减为中等量的病例数明显多于对照组，两组比较差异有统计学意义（χ2＝5．705，P ＜0．05）。对照组多巴胺治疗后尿素氮、血肌酐与治疗前比较，有一定程度的改善，但差异无统计学意义（P 值均＞0．05），尿量治疗前后比较差异有统计学意义（t ＝15．534，P ＜0．01）。治疗组用特利加压素治疗前后尿素氮、血肌酐、尿量比较，差异均具有统计学意义（t 值分别为11．535、9．941、19．685，P 值均＜0．01）；两组治疗后比较尿素氮、血肌酐、尿量变化，差异均具有统计学意义（t 值分别为7．317、9．284、9．839，P 值均＜0．01）。治疗组特利加压素每8 h 给药1次比每12 h 给药1次尿素氮、血肌酐、尿量改善更明显，但治疗后两组比较差异均无统计学意义（P 值均＞0．05）。特利加压素不良反应轻微，患者基本能耐受。结论国产特利加压素联合 Alb 治疗Ⅱ型 HRS 疗效明显，不良反应小，值得临床推广。
목적：관찰국산특리가압소치료Ⅱ형간신종합정（HRS）적료효。방법선취2011년11월－2014년6월상해시포동신구남화의원수치적25례Ⅱ형 HRS 환자작위치료조，2011년전용다파알치료적28례Ⅱ형 HRS 환자작위대조조。치료조수궤분성량조，기중일조（12례）매8 h 급약1차，령일조（13례）매12 h 급약1차。량조급약전균여이백단백（Alb）확용，료정균위7 d。관찰량조환자치료전후증상개선정황，뇨소담、혈청기항、전해질、뇨량、간공능변화급복수소퇴정황。계수자료조간비교채용χ2검험，계량자료조간비교채용 t 검험。결과대조조환자증상개선불명현，치료조환자증상균득도불동정도적개선。량조환자치료전후간공능、혈청납균무명현변화。치료조환자복수종대량감위중등량적병례수명현다우대조조，량조비교차이유통계학의의（χ2＝5．705，P ＜0．05）。대조조다파알치료후뇨소담、혈기항여치료전비교，유일정정도적개선，단차이무통계학의의（P 치균＞0．05），뇨량치료전후비교차이유통계학의의（t ＝15．534，P ＜0．01）。치료조용특리가압소치료전후뇨소담、혈기항、뇨량비교，차이균구유통계학의의（t 치분별위11．535、9．941、19．685，P 치균＜0．01）；량조치료후비교뇨소담、혈기항、뇨량변화，차이균구유통계학의의（t 치분별위7．317、9．284、9．839，P 치균＜0．01）。치료조특리가압소매8 h 급약1차비매12 h 급약1차뇨소담、혈기항、뇨량개선경명현，단치료후량조비교차이균무통계학의의（P 치균＞0．05）。특리가압소불량반응경미，환자기본능내수。결론국산특리가압소연합 Alb 치료Ⅱ형 HRS 료효명현，불량반응소，치득림상추엄。
Objective To investigate the clinical efficacy of domestic terlipressin in the treatment of type II hepatorenal syndrome (HRS -II).Methods A total of 25 HRS -II patients admitted to our hospital from November 2011 to June 2014 were recruited into the treatment group,and 28 HRS -II patients treated with dopamine before 2011 were recruited into the control group.Patients in the treatment group were randomly divided into two subgroups:one subgroup (n =12)was given terlipressin once every 8 h,and the other subgroup (n =13) was given terlipressin once every 12 h.Both groups received albumin (Alb)infusion to expand the blood volume before treatment with terlip-ressin or dopamine,and the course of treatment was 7 days.The improvement in clinical symptoms,levels of blood urea nitrogen (BUN), serum creatinine and electrolytes,urine volume,changes in liver function,and ascites disappearance in the two groups before and after treat-ment were compared.Comparison of categorical data between the two groups was made by χ2 test,and comparison of continuous data was made by t test.Results Patients in the control group showed no obvious symptom relief,but those in the treatment group had varying de-grees of improvement in clinical symptoms.Neither group had significant changes in liver function and serum sodium level after treatment. The treatment group had significantly more patients whose ascites volume had decreased from large to medium than the control group (χ2 =5.705,P <0.05).There was a slight but not significant decrease in the levels of BUN and serum creatinine in the control group after treat-ment with dopamine (all P >0.05),whereas the urine volume showed significant difference after the treatment (t =15.534,P <0.01). The treatment group showed significant differences in the levels of BUN and serum creatinine and urine volume after terlipressin treatment (t=11.535,9.941,and 19.685,respectively;all P <0.01),and significant differences in those levels were also observed compared with the control group after dopamine treatment (t =7.317,9.284,and 9.839;all P <0.01).Larger changes in BUN,serum creatinine,and urine volume were observed in the subgroup receiving terlipressin every 8 h than in that receiving terlipressin every 12 h,but the differences were not significant (all P >0.05).Patients treated with terlipressin had mild and tolerable adverse reactions.Conclusion The domestic terlipressin combined with albumin infusion has good clinical efficacy and mild adverse effects in treating HRS -II.Its clinical application is highly recommended.