特利加压素对顽固性肝硬化腹水的治疗作用与效应特点观察  

Observation of the therapeutic and characteristic effects of terlipressin on refractory cirrhotic ascites

作　　者：邢枫[1] 李爽 张建军 孙长宇[4] 黄建荣 高泽立 朱亭亭 赵强[1] 张华[1] 刘成海[1,7,8] Xing Feng;Li Shuang;Zhang Jianjun;Sun Changyu;Huang Jianrong;Gao Zeli;Zhu Tingting;Zhao Qiang;Zhang Hua;Liu Chenghai(Second Department of Liver Diseases,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Institute of Liver Diseases,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Gastroenterology,Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 201900,China;Department of Integrated Liver Diseases,Zhongshan Hospital of Hubei Province,Wuhan 430033,China;Department of Infectious Diseases,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Infectious Diseases,The First Affiliated Hospital,Zhejiang University,Hangzhou 310003,China;Department of Gastroenterology,Pudong New Area Hospital,Shanghai 201299,China;Shanghai Key Laboratory of Traditional Chinese Clinical Medicine,Shanghai 201203,China;Shanghai Innovation Center of TCM Health Service,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院肝病二科,上海中医药大学肝病研究所,201203 [2]上海市宝山区中西医结合医院消化内科,201900 [3]湖北省中山医院中西医结合肝病科,430033 [4]郑州大学第一附属医院感染科,450052 [5]浙江大学附属第一医院感染病科,310003 [6]上海市浦东新区人民医院消化内科,201299 [7]上海市中医临床重点实验室,201203 [8]上海中医健康服务协同创新中心,201203

出　　处：《中华肝脏病杂志》2019年第12期982-988,共7页Chinese Journal of Hepatology

基　　金：国家自然科学基金(81473479)。

摘　　要：目的观察特利加压素对肝硬化顽固性腹水(RA)的疗效作用及急性肾损伤(AKI)对该作用的影响。方法采用非随机对照临床试验,收集上海中医药大学附属曙光医院、上海市宝山区中西医结合医院、湖北省中山医院、郑州大学第一附属医院、浙江大学附属第一医院及上海市浦东新区人民医院等2015年3月至2017年3月间收治的111例肝硬化伴RA住院患者资料,分为常规治疗组(对照组)26例,其中RA未合并AKI(RA-NAKI)与RA合并AKI(RA-AKI)患者各13例,治疗包括利尿、补充白蛋白及合并细菌感染者使用抗菌药物等;特利加压素联合治疗组(特利组)85例,其中RA-NAKI患者27例,RA-AKI患者58例,在对照组基础上,加用特利加压素1 mg静脉滴注或微泵静脉推注(每12 h 1次~每6 h 1次)5 d以上。治疗2周,随访4周。比较各组治疗前、治疗1周、2周及随访4周的超声检测仰卧位肝前腹水及最深腹水的深度、体质量、24 h尿量、腹围、平均动脉压(MAP)、肝肾功能等。计数资料用χ^2检验。基线4组样本比较,正态分布资料采用单因素方差分析,非正态分布资料用Kruskal-Wallis H检验。采用重复测量方差分析,比较组内治疗前后不同时点序列疗效差异。组内两两比较采用单因素方差分析LSD法;两组间不同时点序列疗效差异比较采用独立样本t检验;两组非正态分布资料间比较采用Mann-Whitney秩和检验。结果(1)特利组和对照组的RA-NAKI与RA-AKI亚组共4组间基线资料比较:对照组的年龄高于特利组,RA-AKI组的血清肌酐(SCr)高于RA-NAKI组,其余基线资料与合并用药等差异均无统计学意义(P值均>0.05)。(2)特利组与对照组治疗前后组内比较:患者体质量、腹围及最深腹水降低、血清白蛋白均有升高(P<0.05);特利组24 h尿量、MAP明显增加,肝前腹水、SCr及Child-Turcotte-Pugh(CTP)评分降低。治疗前后差值的2组间比较,特利组治疗及随访期体质量、腹围、�Objective To observe the therapeutic effect of terlipressin on refractory ascites(RA)in cirrhosis,and its role and impact on acute kidney injury(AKI).Methods A non-randomized controlled clinical trial data of 111 hospitalized cases of liver cirrhosis accompanied with RA was collected from Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Zhongshan Hospital of Hubei Province,The First Affiliated Hospital of Zhengzhou University,The First Affiliated Hospital of Medical School of Zhejiang University,and People's Hospital of Pudong New Area of Shanghai between March 2015 and March 2017.26 cases of conventional treatment group(control group)were divided into two subgroups:RA without AKI(RA-NAKI)and RA with AKI(RA-AKI),and each subgroup consisted 13 cases.Patients with bacterial infection were treated with diuretics,albumin supplementation and antibiotics.85 cases were presented in terlipressin combined treatment group,of which 27 cases were of RA-NAKI and 58 cases were of RA-AKI.Control group was injected terlipressin 1mg of intravenous drip or static push(once q6 h^12 h)for more than 5 days.The treatment duration lasted for 2 weeks with 4 weeks of follow-up.Body weight,24-hour urine volume,abdominal circumference,mean arterial pressure(MAP),liver and kidney function,anterior hepatic ascites,deepest point of ascites,and ultrasonographic detection of ascites in supine position before treatment,one and two weeks after treatment and 4 weeks after follow-up were compared.Count data were tested by χ^2.Samples of four groups at baseline were compared.One-way analysis of variance was used for normal distribution data and Kruskal-Wallis H test for non-normal distribution data.Repeated measures analysis of variance was used to compare the difference in efficacy between different time points before and after treatment in the group.The LSD method of one-way ANOVA was used to compare the two groups.A t-test of independent samples was used to compare the efficacy of different time series between

关 键 词：肝硬化 腹水 急性肾损伤 特利加压素 

分 类 号：R57[医药卫生—消化系统]