对肝硬化腹水诊治中若干问题的认识与思考  

Current clinical perspectives and implications of cirrhotic ascites in China

作　　者：刘建军 李楠[2] 智红 吴晓英[2] 

机构地区：[1]广州军区第181医院感染-肝病诊疗中心,广西桂林541001 [2]邯郸市第一医院,河北邯郸056002

出　　处：《临床肝胆病杂志》2012年第9期701-703,共3页Journal of Clinical Hepatology

摘　　要：近年国内对肝硬化腹水发病机制、诊断、治疗有较多研究,与既往相比出现了较大差距,突出问题:(1)根据钠潴留机制限钠、利尿治疗不仅未能抑制肾素-血管紧张素-醛固酮系统(RAAS)活性,反而限钠越严格,RAAS活性就越强。纠正低血钠后RAAS活性受到抑制;(2)肝硬化腹水患者并非因血管活性物质紊乱导致血容量不足而诱发肝肾综合征(HRS),而是限钠、利尿导致血容量不足诱发HRS;(3)国外(美国)肝硬化腹水诊治指南部分条款相互间出现矛盾。根据这些突出问题,应重视对肝硬化腹水的研究。In recent years, domestic research efforts have significantly advanced our understanding of the pathogenesis of cirrhotic ascites and led to development of new and improved methods of diagnosis and treatment. Unfortunately, the studies have produced underlying mech- anisms remain unknown systematic studies to compare the new and traditional methods are lacking. There is an urgent need to address the following topics and related issues ： （ 1 ） The mechanism of sodium retention ： Sodium restriction treatment regimens and diuretic therapy have not only failed to inhibit activity of the kidney - angiotensin - aldosterone system （RAAS）, but stricter salt restriction has produced stron- ger RAAS activity. However, correcting hyponatremia effectively inhibited the RAAS activity. （2） The causes and effects of hepatorenal syndrome （HRS） ： The established theory that cirrhotic ascites result from disorders of vasoaetive substances leading to hypovolemia and subse- quent HRS was not shown in patients. However, cirrhosis ascites were shown to be associated with sodium restriction and diuretic status, which is newly theorized to lead to the hypovolemia - induced HRS. （ 3 ） Inconsistencies in established management guidelines ： Some rules of the USA guidelines for therapy of cirrhotic aseites lack a theoretical basis, resulting in contradictions in diagnosis and treatment, which may also be explained by ethnic - specific features. Thus, it is necessary to formulate a new set of guidelines for diagnosis and treatment of cirrhotic ascites in Chinese patients based on a comprehensive understanding of the underlying molecular and biological pathogenic mechanisms.

关 键 词：肝硬化腹水 诊治指南 血管活性物质 血容量不足 利尿治疗 RAAS 醛固酮系统 血管紧张素 

分 类 号：R575.2[医药卫生—消化系统]