国际腹水协会给出了肝肾综合征的定义（HRS）并将快速进展性肾功能衰竭（类型I）与稳定缓和性肾功能损害（类型II）区别开。治疗方法把肝移植作为唯一的能根除疾病的方法，另外还有血液透析，腹水静脉分流，白蛋白透析M.A.R.S.®（分子吸附循环系统）和静脉药物治疗。
过去一些非对照研究报道了TIPS对具有HRS I型和II型的病人的一种有益作用。Lake和其助手观察到了TIPS仅对具有低尿钠排泄<10mEq/天的病人有益。在后来的一系列结果显示生存与肝功能损伤的程度有关。由于未经治疗的I型HRS1年生存率为10%，报道的TIPS后48%的生存率是令人鼓舞的。现在，一个随机化研究正在比较药物治疗与TIPS在治疗I型HRS的对比。现在，TIPS的数据不足以证明这个手术可以用于所有的HRS病人。但是，对于不适于移植者而且保留了一些肝功能者可能是TIPS的适应证。有严重肝损害的病人可以从加强药物治疗或者白蛋白透析M.A.R.S. ®中受益。 HRS is usually manifested in the advanced stage of cirrhosis with PH. HRS(Hepatorenal Syndrome) 发生在门静脉高压肝硬化晚期。（严重肝病晚期可能出现的一种并发症） International Club of Ascites has defined HRS as an increase in serum creatinine ≥ 0.3 mg/dL (≥ 26.5 mmol/L) within 48 h; or a percentage increase in serum creatinine ≥ 50% from the baseline that is known, or presumed, to have occurred within the previous seven days[150].
国际腹水俱乐部（协会）将HRS定义为
1. 48小时内血清肌酐值的增加≥0.3mg/dL(≥26.5mmol/L)； 2. 前七天内发生的比已知或假设基线血清肌酐值的增加≥50%[150]。 As per the recent International Club of Ascites classification, patients with cirrhosis and acute kidney injury (AKI) are subgrouped into HRS AKI and HRS non-AKI[150,151]. 根据最近的国际腹水协会分类，肝硬化和急性肾损伤(AKI)患者分为HRS-AKI和HRS-非AKI[150,151]。 HRS non-AKI is further subdivided into HRS-acute kidney disease and HRS-chronic kidney disease. HRS-非AKI可进一步细分为HRS-急性肾病和HRS-慢性肾病。 In the former, the calculated glomerular filtration rate (eGFR) is < 60 mL/min per 1.73 m2 for < 3 mo in the absence of other (structural) causes along with percent increase in serum creatinine < 50% using the last available value of outpatient creatinine value within 3 mo as the baseline value. 前者中，3个月内在没有其它其它（结构性）原因情况下，估算肾小球滤过率（eGFR）＜60mL/分钟/.73㎡ ，以三个月内门诊患者最后肌酐可用值为基线，肌酐值增加＜50%。 In the latter, the eGFR is < 60 mL/min per 1.73 m2 for ≥ 3 mo in the absence of other (structural) causes. In patients not responding to medical management in the presence of ascites, TIPS is a useful procedure in the management of HRS. 后者，3个月外在没有其它原因的情况下eGFR＜60mL/分钟/.73㎡。 In patients not responding to medical management in the presence of ascites, TIPS is a useful procedure in the management of HRS.
对于腹水对药物管理没有反应的患者，TIPS是管理HRS中的一个有用的治疗。
The utility of TIPS in patients with HRS non-AKI has been discussed previously in the section on RA as most of these patients present with the need for repeated paracentesis.
TIPS在HRS非AKI患者中的应用之前已经在RA部分中讨论过，因为这些患者中的大多数都需要重复穿刺。 In a recent systematic review on TIPS in HRS, nine publications with 128 patients were analyzed. The pooled short-term and 1-year survival rates were 72% and 47% in HRS-AKI and 86% and 64% in HRS non-AKI. The pooled rate of HE after TIPS was 49%. The pooled rate of renal function improvement post-TIPS was 93% in HRS-AKI and 83% in any type of HRS. Post-procedure, creatinine, blood urea nitrogen, serum sodium, sodium excretion, and urine volume significantly improved with a nonsignificant elevation in serum bilirubin[152].
在最近一项关于HRS的TIPS的系统综述中，我们分析了9篇共128例患者的论文。HRS-AKI的合并短期和1年生存率分别为72%和47%，HRS非AKI的合并短期生存率分别为86%和64%。TIPS后HE的合并率为49%。TIPS-术后HRS-AKI的肾功能改善率为93%，任何类型的HRS均为83%。术后、肌酐、血尿素氮、血清钠、钠排泄量和尿量显著改善，血清胆红素[152]不显著升高。
The use of TIPS in patients with HRS-AKI remains controversial since a majority of these patients are sick at presentation with sepsis or acute decompensation. A recent retrospective cohort study in HRS patients showed TIPS is a relatively safe, bridging therapeutic option in patients who underwent TIPS in comparison to patients who received dialysis[153]. Decreased recurrence of ascites and increased incidence of HE in the TIPS group was seen in a small randomized study where they compared patients with Type 2 HRS (HRS non-AKI) who underwent TIPS with another group of patients receiving paracentesis plus albumin[81]. TIPS may prevent permanent renal damage and the need for further liver-kidney transplantation due to portosystemic shunting and resultant hemodynamic changes[154]. However, further RCTs showing the role of TIPS in HRS patients are required. 在HRS-AKI患者中使用TIPS仍然存在争议，因为这些患者中的大多数患者表现为脓毒症或急性失代偿。最近一项针对HRS患者的回顾性队列研究显示，与接受透析[153]的患者相比，在接受TIPS的患者中，TIPS是一种相对安全的桥接治疗选择。在一项小型随机研究中，TIPS组的腹水复发减少和HE发生率增加，他们将2型HRS(HRSnon-AKI)患者与另一组接受穿刺加白蛋白[81]的患者进行了比较。TIPS可以防止永久性肾损伤和进一步的肾损伤和需要进一步的肝移植。然而，还需要进一步显示TIPS在HRS患者中的作用的rct。 |