摘要
目的观察应用特利加压素联合白蛋白输注治疗肝硬化并发Ⅱ型肝肾综合征患者的临床效果及血清血管紧张素Ⅱ(AngⅡ)、尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)和尿肾损伤因子-1(uKIM-1)水平的变化。方法2017年7月~2019年5月我院收治的60例肝硬化并发Ⅱ型肝肾综合征患者,采用随机数字表法分为对照组30例和观察组30例,分别给予静脉滴注白蛋白或在此基础上,应用特利加压素治疗,观察两周。采用化学发光法检测血清AngⅡ水平;采用ELISA法检测uKIM-1水平,采用胶体金法检测uNGAL水平。结果在治疗两周末,观察组腹水消退和尿量增加等有效率为85.3%,显著大于对照组的63.3%(P<0.05);观察组24 h尿量为(1256.7±530.5)mL,显著大于对照组[(824.9±384.4)mL,P<0.05],体质量为(51.8±4.5)kg,显著低于对照组[(57.6±4.8)kg,P<0.05],腹围为(88.2±5.8)cm,显著小于对照组[(95.7±6.4)cm,P<0.05];观察组尿素氮(BUN)水平为(10.8±2.4)mmol/L,显著低于对照组[(14.7±3.2)mmol/L,P<0.05],sCr水平为(139.7±14.4)μmol/L,显著低于对照组[(154.9±17.5)μmol/L,P<0.05],血钠水平为(135.8±8.2)mmol/L,显著高于对照组[(132.2±7.9)mmol/L,P<0.05];观察组血清AngⅡ水平为(14.6±1.5)pg/mL,显著低于对照组[(18.3±1.8)pg/mL,P<0.05],uNGAL水平为(1.0±0.4)μg/L,显著低于对照组[(1.2±0.2)μg/L,P<0.05],uKIM-1水平为(3.8±0.4)μg/L,显著低于对照组[(4.4±0.3)μg/L,P<0.05]。结论应用特利加压素联合白蛋白输注治疗肝硬化并发Ⅱ型肝肾综合征患者能显著增加尿量,消退腹水,改善肾功能,可能与降低了血清AngⅡ水平,增加尿uNGAL和uKIM-1排泄有关,值得临床进一步观察。
Objective The aim of this study was to observe the efficacy of terlipressin in combination with albumin infusion for patients with cirrhosis complicated by typeⅡhepatorenal syndrome(HRS).Methods 60 patients with liver cirrhosis and typeⅡHRS were admitted to our hospital between July 2017 and May 2019,and were randomly divided into two groups,with 30 in each group.The patients in the control group were treated with intravenous albumin infusion,and those in the observation group were treated with intravenous terlipressin infusion at the basis of treatment in the control group for two weeks.Serum angiotensinⅡ(AngⅡ),urine neutrophils enzyme related lipid carrier protein gelatin(uNGAL),and urine kidney damage factor 1(uKIM-1)were detected.Results At the end of two week treatment,the total effective rate in the observation group was 85.3%,significantly higher than that in the control group(63.3%,P<0.05);the 24 h urine volume in the observation group was(1256.7±530.5)mL,significantly higher than that in the control group[(824.9±384.4)mL,P<0.05],the body mass was(51.8±4.5)kg,significantly lower than in the control group[(57.6±4.8)kg,P<0.05],and the abdominal circumference was(88.2±5.8)cm,significantly lower than in the control group[(95.7±6.4)cm,P<0.05];the urea nitrogen level in the observation group was(10.8±2.4)mmol/L,significantly lower than that in the control group[(14.7±3.2)mmol/L,P<0.05],the creatinine level was(139.7±14.4)mol/L,significantly lower than in the control group[(154.9±17.5)mol/L,P<0.05],and serum sodium level was(135.8±8.2)mmol/L,significantly higher than in the control group[(132.2±7.9)mmol/L,P<0.05];serum AngⅡlevel was(14.6±1.5)pg/mL,significantly lower than in the control group[(18.3±1.8)pg/mL,P<0.05],the uNGAL level was(1.0±0.4)g/L,significantly lower than in the control group[(1.2±0.2)g/L,P<0.05],and the level of ukim-1 was(3.8±0.4)g/L,significantly lower than that in the control group[(4.4±0.3)g/L,P<0.05].Conclusion The combination of intravenous administration of terlipressin and albumin could significantly improve the glomerular filtration functions,increase urine volume,which might be related to the reduction of serum AngⅡ,uNGAL,and uKIM-1 levels.
作者
潘泓多
党彤
周怡
武芸
Pan Hongduo;Dang Tong;Zhou Yi(Department of Gastroenterology,Second Affiliated Hospital,Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014030,Inner Mongolia Autonomous Region,China)
出处
《实用肝脏病杂志》
CAS
2020年第6期861-864,共4页
Journal of Practical Hepatology
基金
内蒙古自治区自然科学基金资助项目(编号2018MS08050)。
