肝肾综合征的中西医结合诊治

摘要: 肝肾综合征(HRS)是终末期肝病常见的并发症，是在严重肝病基础上发生的功能性急性肾衰竭，是以肾功能不全、内源性血管活性物质异常和动脉循环血流动力学改变为特征的一组临床综合征。HRS较为理想的治疗是肝移植或同时肾移植，优化药物与非药物治疗方法是治疗HRS的关键。本文对目前中西医诊断和治疗HRS的现状予以回顾总结。
- 肝肾综合征 /
- 诊断 /
- 中西医结合疗法
Abstract: As a common complication of end-stage liver disease, hepatorenal syndrome (HRS) is functional acute renal failure that occurs on the basis of severe liver diseases and is a group of clinical syndromes characterized by renal insufficiency, abnormal endogenous vascular substances, and hemodynamic changes of arterial circulation. The ideal treatment method for HRS is liver transplantation or simultaneous kidney transplantation, and optimization of drug and non-drug therapies is the key to the treatment of HRS. This article reviews the current status of the integrated traditional Chinese and Western medicine diagnosis and treatment of HRS.
- Hepatorenal Syndrome /
- Diagnosis /
- TCM WM Therapy

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表 1 国际腹水俱乐部2015年制定的HRS诊断分型

Table 1. Diagnosis and classification of HRS formulated by International Club of Ascites in 2015

HRS-AKI

HRS-NAKI

(1)48 h内SCr升高≥0.3 mg/dL(26.5 μmol/L)或SCr比基线增加≥1.5倍(如果有前3个月内的SCr，可用作基线，应使用最接近临床表现的值)；
(2) 停用利尿剂并使用白蛋白扩容至少2 d后无应答，白蛋白推荐剂量1 g·kg^-1·d^-1；
(3) 肝硬化合并腹水；
(4) 无休克史；
(5) 目前或近期未使用肾毒性药物(非甾体抗炎药、造影剂等)；
(6) 没有结构性肾损伤的迹象
  ① 无蛋白尿(＞500 mg/d)
  ② 无血尿(＞50个红细胞/高倍视野)
  ③ 肾脏超声检查结果正常

HRS-AKD
(1) 在没有其他潜在肾脏疾病原因的情况下，eGFR＜60 mL·min^-1·1.73 m^-2，持续时间＜3个月；
(2) 以3个月内最后一次可用的门诊SCr水平作为基线值，SCr增加百分比＜50%
HRS-CKD
在没有其他潜在肾脏疾病原因的情况下，eGFR＜60 mL·min^-1·1.73 m^-2，持续时间≥3个月

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