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特利加压素治疗失代偿期肝硬化并发低钠血症的机制和处理原则

游佳 江家骥

引用本文:
Citation:

特利加压素治疗失代偿期肝硬化并发低钠血症的机制和处理原则

DOI: 10.3969/j.issn.1001-5256.2016.11.043
基金项目: 

福建省卫生厅青年课题立项单位资助项目(2012-2-48); 

详细信息
  • 中图分类号: R575.2

Mechanisms of hyponatremia in patients with decompensated liver cirrhosis treated with terlipressin and related treatment principles

Research funding: 

 

  • 摘要: 食管胃静脉曲张出血和肝肾综合征是失代偿期肝硬化患者门静脉高压的常见并发症,特利加压素可以收缩内脏血管、降低门静脉压力、增加肾脏灌注,是一线治疗药物。近年来陆续报道了部分患者在接受特利加压素治疗期间发生了低钠血症。由于肝硬化患者本身容易发生低钠血症,使用特利加压素可能不利于患者血钠水平的管理。总结了特利加压素治疗期间低钠血症的发生率以及危险因素,主要介绍了特利加压素治疗失代偿期肝硬化患者期间低钠血症的发生机制以及低钠血症的处理原则,若能控制低钠血症的发生,特利加压素则是治疗门静脉高压并发症的有效药物。

     

  • [1]MOLLER S,HANSEN EF,BECKER U,et al.Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients[J].Liver,2000,20(1):51-59.
    [2]ARROYO V,GUEVARA M,GINES P.Hepatorenal syndrome in cirrhosis:pathogenesis and treatment[J].Gastroenterology,2002,122(6):1658-1676.
    [3]de FRANCHIS R,BavenoⅥFaculty.Expanding consensus in portal hypertension:Report of the BavenoⅥConsensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol,2015,63(3):743-752.
    [4]TRIPATHI D,STANLEY AJ,HAYES PC,et al.UK guidelines on the management of variceal haemorrhage in cirrhotic patients[J].Gut,2015,64(11):1680-1704.
    [5]Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association;Chinese Society of Endoscopy,Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会,等.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,32(2):203-219.
    [6]ANGELI P,GINS P,WONG F,et al.Diagnosis and management of acute kidney injury in patients with cirrhosis:revised consensus recommendations of the International Club of Ascites[J].Gut,2015,64(4):531-537.
    [7]RUNYON BA,AASLD.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis2012[J].Hepatology,2013,57(4):1651-1653.
    [8]DING XH,GU JY.Clinical efficacy of terlipressin in treatment of typeⅡhepatorenal syndrome[J].J Clin Hepatol,2015,31(5):745-748.(in Chinese)丁晓红,顾建英.特利加压素治疗Ⅱ型肝肾综合征的临床疗效观察[J].临床肝胆病杂志,2015,31(5):745-748.
    [9]JOHN S,THULUVATH PJ.Hyponatremia in cirrhosis:pathophysiology and management[J].World J Gastroenterol,2015,21(11):3197-3205.
    [10]GINS P,BERL T,BERNARDI M,et al.Hyponatraemia in cirrhosis:from pathogenesis to treatment[J].Hepatology,1998,28(3):851-864.
    [11]JALAN R,HAYES PC.Sodium handling in patients with well compensated cirrhosis is dependent on the severity of liver disease and portal pressure[J].Gut,2000,46(4):527-533.
    [12]GEILSWIJK M,THOMSEN KL,PEDERSEN EB,et al.Urinary aquaporin-2 excretion before and after transjugular intrahepatic portosystemic shunt insertion for refractory ascites[J].Scand J Gastroenterol,2015,50(4):454-461.
    [13]NAKANISHI H,KUROSAKI M,HOSOKAWA T,et al.Urinary excretion of the water channel aquaporin 2 correlated with the pharmacological effect of tolvaptan in cirrhotic patients with ascites[J].J Gastroenterol,2016,51(6):620-627.
    [14]CHEN C,CHEN RP,LIN HH,et al.Tolvaptan regulates aquaporin-2 and fecal water in cirrhotic rats with ascites[J].World J Gastroenterol,2016,22(12):3363-3371.
    [15]HUANG YY,SUN JY,WANG JY,et al.Terlipressin resolves ascites of cirrhotic rats through downregulation of aquaporin 2[J].J Int Med Res,2012,40(5):1735-1744.
    [16]ESTEVA-FONT C,BACCARO ME,FERNNDEZ-LLAMA P,et al.Aquaporin-1 and aquaporin-2 urinary excretion in cirrhosis:relationship with ascites and hepatorenal syndrome[J].Hepatology,2006,44(6):1555-1563.
    [17]LEE WC,LIN HC,YANG YY,et al.Hemodynamic effects of a combination of prazosin and terlipressin in patients with viral cirrhosis[J].Am J Gastroenterol,2001,96(4):1210-1216.
    [18]TRIANTOA CK,SAMONAKIS D,THALHEIMER U,et al.Terlipressin therapy for renal failure in cirrhosis[J].Eur J Gastroenterol Hepatol,2010,22(4):481-486.
    [19]FERNNDEZ-VARO G,ORD,CABLE E,et al.Evasopressin 1αreceptor partial agonist increases sodium excretion and reduces portal hypertension and ascites in cirrhotic rats[J].Hepatology,2016,63(1):207-216.
    [20]FENTON RA,KNEPPER MA.Mouse models and the urinary concentrating mechanism in the new millennium[J].Physiol Rev,2007,87(4):1083-1112.
    [21]FEU F,RUIZ del ARBOL L,BANARES R,et al.Doubleblind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage.Variceal Bleeding Study Group[J].Gastroenterology,1996,111(5):1291-1299.
    [22]ESCORSELL A,ARBOL LRD,PLANAS R,et al.Multicenter randomized controlled trial of terlipressin versus sclerotherapy in the treatment of acute variceal bleeding:the TEST study[J].Hepatology,2000,32(3):471-476.
    [23]SOLA E,LENS S,GUEVARA M,et al.Hyponatremia in patients treated with terlipressin for severe gastrointestinal bleeding due to portal hypertension[J].Hepatology,2010,52(5):1783-1790.
    [24]YIM SY,SEO YS,JUNG CH,et al.Risk factors for developing hyponatremia during terlipressin treatment:a retrospective analyses in variceal bleeding[J].J Clin Gastroenterol,2015,49(7):607-612.
    [25]KANG YJ,BAE EJ,HWANG K,et al.Initial serum sodium concentration determines the decrease in sodium level after terlipressin administration in patients with liver cirrhosis[J].Springerplus,2013,2:519.
    [26]ZAKI SA.Terlipressin-induced hyponatremic seizure in a child[J].Indian J Pharmacol,2013,45(4):403-404.
    [27]BRUHA R,MARECEK Z,PROCHAZKA V,et al.Doubleblind randomized multicenter study comparing the efficacy and safety of 10-day to 5-day terlipressin treatment of bleeding esophageal varices[J].Hepatogastroenterology,2009,56(90):390-394.
    [28]CHANG TT,LEE FY,TSAI YT,et al.A randomized control ed study of low-dose and high-dose terlipressin in the control of acute oesophageal variceal haemorrhage[J].J Gastroenterol Hepatol,1991,6(5):481-484.
    [29]KRAG A,BENDTSEN F,PEDERSEN EB.Effects of terlipressin on the aquaretic system:evidence of antidiuretic effects[J].Am J Physiol Renal Physiol,2008,295(5):1295-1300.
    [30]NIELSEN S,FROKIAR J,MARPLES D,et al.Aquaporins in the kidney:from molecules to medicine[J].Physiol Rev,2002,82(1):205-244.
    [31]KALAMBOKIS GN,PAPPAS K,BALTAYIANNIS G.Effects of terlipressin on water excretion after oral water load test in nonazotemic cirrhotic patients with ascites without hyponatremia[J].Scand J Gastroenterol,2010,45(12):1509-1515.
    [32]BANKIR L.Antidiuretic action of vasopressin:quantitative aspects and interaction between V1a and V2 receptor-mediated effects[J].Cardiovasc Res,2001,51(3):372-390.
    [33]URIZ J,GINES P,CARDENAS A,et al.Terlipressin plus albumin infusion:an effective and safe therapy of hepatorenal syndrome[J].J Hepatol,2000,33(1):43-48.
    [34]ORTEGA R,GINES P,URIZ J,et al.Terlipressin therapy with and without albumin for patients with hepatorenal syndrome:results of a prospective,nonrandomized study[see comment][J].Hepatology,2002,36(4 Pt 1):941-948.
    [35]BOYER TD,SANYAL AJ,GARCIA-TSAO G,et al.Terlipressin Study Group.Predictors of response to terlipressin plus albumin in hepatorenal syndrome(HRS)type 1:relationship of serum creatinine to hemodynamics[J].J Hepatol,2011,55(2):315-321.
    [36]SHARMA P,SINGH S,SARIN SK.Hyponatremia in patients with acute variceal bleeding treated with terlipressin[J].Hepatology,2011,53(2):714.
    [37]DUNWOODIE E,JOWETT S.Terlipressin causing a hyponatraemic seizure[J].Scand J Gastroenterol,2007,42(5):665.
    [38]SIMA M,POKORNY M,PAD OUR F.Terlipressin induced severe hyponatremia[J].Prague Med Rep,2016,117(1):68-72.
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  • 出版日期:  2016-11-20
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