Ann Palliat Med:大剂量乌司他丁可预防原位肝移植术后晚期急性肾衰竭的发生

2021-02-28 MedSci原创 MedSci原创

原位肝移植(Orthotopic liver transplantation,OLT)是治疗终末期肝病和急性肝衰竭最有效的方法之一。OLT术后常发生多器官功能障碍综合征(MODS),急性肾损伤(AKI

原位肝移植(Orthotopic liver transplantation,OLT)是治疗终末期肝病和急性肝衰竭最有效的方法之一。OLT术后常发生多器官功能障碍综合征(MODS),急性肾损伤(AKI)是OLT术后最常见的MODS类型之一。乌司他丁是一种蛋白酶抑制剂,可抑制内源性蛋白酶,保护各种类型的休克、缺血再灌注器官损伤、多器官功能障碍和重症胰腺炎,并抑制手术相关的肾功能恶化。虽然乌司他丁的最大推荐日剂量为3×105 U,但治疗急性或慢性胰腺炎、严重感染、急性器官衰竭等重症急性疾病所需达到治疗浓度的剂量要高得多。本研究旨在探讨高剂量乌司他丁(160万U/d)对高危患者(术中失血量≥2000 mL)OLT术后严重阶段AKI的预防效果,研究结果已发表于Ann Palliat Med。

将接受OLT的174名高危受术者按乌力他汀剂量分为两组:低剂量(LD)乌力他汀组55名,80万U/d;高剂量(HD)乌力他汀组119名,160万U/d。主要结局是LARF的发生率,定义为移植后7-28天内新发生的AKI III期(KDIGO,2012)。次要结果是早期多器官检索评估、住院时间和安全事件。

 

结果显示,LD(8/55,14.50%)和HD(9/119,7.56%)乌司他丁组之间LARF的发生率没有显著差异(HD vs. LD,HR,0.49;95%CI,0.17-1.37;p = .1295)。多变量Cox比例风险回归模型显示HD乌司他丁(HR,0.57;95%CI,0.38-0.98;p = .0464)是LARF的独立保护因素。与LD乌司他丁组相比,HD 乌司他丁组早期乳酸水平、氧合、AKI期、移植物功能和顺序器官衰竭评估[SOFA]评分均有显著改善。两组均未观察到明显的不良事件。

综上所述,该研究结果表明,更高剂量的乌利他汀(160万U/d)可能是预防OLT后LARF的较好选择,可能有助于增强早期多器官的恢复,从而减轻LARF的发生率。

 

原始出处:

 

Hai Wang He, Hong Zhang. The efficacy of different doses of ulinastatin in the treatment of severe acute pancreatitis. Ann Palliat Med. 2020 May;9(3):730-737. doi: 10.21037/apm.2020.04.19.  

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    2021-04-28 cy0324
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    2021-03-02 科研科研科研

    原位肝转移术后晚期记性肾衰竭发生

    0

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    2021-03-02 膀胱癌
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    2021-03-02 hb2008ye

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