白蛋白与肝硬化刘文徽7-10.pptVIP

* * * . * * * * * * * * * * * * * * * * * * * * European guidelines for the management of hepatorenal syndrome EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397–417 Monitor carefully, screen for sepsis Consider LVP with albumin if indicated Suspend diuretics during diagnosis and evaluation Albumin with terlipressin is first-line drug therapy Liver transplantation is the optimal treatment HRS should be treated before the procedure to improve outcomes 小 结 HRS预后极差。 研究表明，白蛋白与血管加压素联合应用可显著改善HRS的治疗效果。 欧洲指南推荐白蛋白+血管活性药作为HRS的一线治疗药物。 Conclusions总 结 Hepatic indications for albumin PPCD, post-paracentesis circulatory dysfunction; LVP, large-volume paracentesis; SBP, spontaneous bacterial peritonitis; HRS, hepatorenal syndrome There are three main indications for volume replacement with albumin in liver disease prevention of PPCD following LVP prevention of renal failure in patients with SBP treatment of HRS (as an adjunct to vasoconstrictors) Supported by several clinical studies and meta-analyses Advocated by European and American guidelines Increased risk Complication Treatment Outcome Increased risk *Albumin recommended in EASL4 and AASLD5 guidelines LVP, large-volume paracentesis; PPCD, post-paracentesis circulatory dysfunction 1Bernardi et al. Hepatology 2012; 55: 1172–1181; 2Ortega et al. Hepatology 2002; 36: 941–948; 3Sort et al. N Engl J Med 1999; 341: 403–409; 4EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397–417; 5Runyon et al. Hepatology 2009; 49: 2087–2107 Hepatic indications for albumin (cont’d) LVP (5 L) + Albumin* VasoconstrictOr + Albumin* Antibiotic 抗生素 + Albumin* ↓ PPCD1 ↓ hyponatraemia1 ↓ Mortality1 ↓ Renal impairment2 ↓ Mortality2 ↓ Renal impairment3 ↓ Mortality3 Large/grade 3 ascites Hepatorenal synd