肝肾综合征肾脏生物标志物的研究进展
DOI: 10.3969/j.issn.1001-5256.2023.09.029
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:孙榕负责课题设计,资料分析,撰写论文;姜利参与修改论文,拟定写作思路,指导撰写文章并最后定稿。
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摘要: 肝肾综合征(HRS)是终末期肝硬化的主要并发症之一,其最主要特征是肾脏血管过度收缩导致的肾脏血流量和肾小球滤过率降低。目前,尽管在临床上常使用血管收缩药物联合人血白蛋白作为治疗HRS的一线治疗选择,但肝移植是治愈HRS的唯一方法,在没有进行肝移植治疗的情况下,患者病情迅速恶化甚至死亡。早期识别肝硬化患者HRS有利于及时采取有效治疗措施。近年来,生物标志物在HRS的早期预警价值受到广泛关注。本文简要介绍了生物标志物在HRS早期诊断中的意义,以期为临床诊治提供优选策略。Abstract: Hepatorenal syndrome (HRS) is one of the major complications of end-stage liver cirrhosis and is characterized by reductions in renal blood flow and glomerular filtration rate due to excessive contraction of renal vessels. Although vasoconstrictor combined with human serum albumin is currently used as the first-line treatment option for HRS, liver transplantation is the only way to cure HRS, and without liver transplantation, patient condition deteriorates rapidly and even leads to death. Early identification of HRS in patients with liver cirrhosis may help to adopt timely and effective treatment measures. In recent years, the early warning value of biomarkers in HRS has attracted wide attention. This article briefly introduces the significance of biomarkers in the early diagnosis of HRS, in order to provide optimal strategies for clinical diagnosis and treatment.
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Key words:
- Liver Cirrhosis /
- Hepatorenal Syndrome /
- Acute Kidney Injury /
- Biomarkers
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[1] SIMONETTO DA, GINES P, KAMATH PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management[J]. BMJ, 2020, 370: m2687. DOI: 10.1136/bmj.m2687. [2] ANGELI P, GINÈS P, WONG F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites[J]. J Hepatol, 2015, 62( 4): 968- 974. DOI: 10.1016/j.jhep.2014.12.029. [3] ALESSANDRIA C, OZDOGAN O, GUEVARA M, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation[J]. Hepatology, 2005, 41( 6): 1282- 1289. DOI: 10.1002/hep.20687. [4] DU H, BAI XF. Pathogenesis of hepatorenal syndrome[J]. J Clin Inter Med, 2012, 29( 12): 797- 799. DOI: 10.3969/j.issn.1001-9057.2012.12.001. [5] MINDIKOGLU AL, PAPPAS SC. New developments in hepatorenal syndrome[J]. Clin Gastroenterol Hepatol, 2018, 16( 2): 162- 177. e 1. DOI: 10.1016/j.cgh.2017.05.041. [6] LI HJ, XIONG ZG, WANG J, et al. Establishment and validation of an estimating formula for glomerular filtration rate based on Cystain C[J]. Int J Lab Med, 2013, 34( 5): 562- 567. DOI: 10.3969/j.issn.1673-4130.2013.05.022. [7] CHANCHAROENTHANA W, LEELAHAVANICHKUL A. Acute kidney injury spectrum in patients with chronic liver disease: Where do we stand?[J]. World J Gastroenterol, 2019, 25( 28): 3684- 3703. DOI: 10.3748/wjg.v25.i28.3684. [8] AMIN AA, ALABSAWY EI, JALAN R, et al. Epidemiology, pathophysiology, and management of hepatorenal syndrome[J]. Semin Nephrol, 2019, 39( 1): 17- 30. DOI: 10.1016/j.semnephrol.2018.10.002. [9] GUPTA K, BHURWAL A, LAW C, et al. Acute kidney injury and hepatorenal syndrome in cirrhosis[J]. World J Gastroenterol, 2021, 27( 26): 3984- 4003. DOI: 10.3748/wjg.v27.i26.3984. [10] KAZORY A, RONCO C, Hepatorenal syndrome or hepatocardiorenal syndrome:Revisiting basic concepts in view of emerging data[J]. Cardiorenal Med, 2019, 9( 1): 1- 7. DOI: 10.1159/000492791. [11] NAZAR A, GUEVARA M, SITGES M, et al. LEFT ventricular function assessed by echocardiography in cirrhosis: relationship to systemic hemodynamics and renal dysfunction[J]. J Hepatol, 2013, 58( 1): 51- 57. DOI: 10.1016/j.jhep.2012.08.027. [12] FRANCOZ C, DURAND F, KAHN JA, et al. Hepatorenal syndrome[J]. Clin J Am Soc Nephrol, 2019, 14( 5): 774- 781. DOI: 10.2215/CJN.12451018. [13] CSAK T, BERNSTEIN D. Hepatorenal syndrome: pathophysiology[J]. Clin Liver Dis, 2022, 26( 2): 165- 179. DOI: 10.1016/j.cld.2022.01.013. [14] LIAO XH, YE JZ, ZHONG BH. Pathogenesis of hepatorenal syndrome[J]. J Clin Hepatol, 2020, 36( 11): 2406- 2410. DOI: 10.3969/j.issn.1001-5256.2020.11.002 [15] OBERT LA, ELMORE SA, ENNULAT D, et al. A Review of specific biomarkers of chronic renal injury and their potential application in nonclinical safety assessment studies[J]. Toxicol Pathol, 2021, 49( 5): 996- 1023. DOI: 10.1177/0192623320985045. [16] ALLEGRETTI AS, SOLÀ E, GINÈS P. Clinical application of kidney biomarkers in cirrhosis[J]. Am J Kidney Dis, 2020, 76( 5): 710- 719. DOI: 10.1053/j.ajkd.2020.03.016. [17] TENSTAD O, ROALD AB, GRUBB A, et al. Renal handling of radiolabelled human cystatin C in the rat[J]. Scand J Clin Lab Invest, 1996, 56( 5): 409- 414. DOI: 10.3109/00365519609088795. [18] KIESSLING AH, DIETZ J, REYHER C, et al. Early postoperative serum cystatin C predicts severe acute kidney injury following cardiac surgery: a post-hoc analysis of a randomized controlled trial[J]. J Cardiothorac Surg, 2014, 9: 10. DOI: 10.1186/1749-8090-9-10. [19] SHLIPAK MG, CORESH J, GANSEVOORT RT. Cystatin C versus creatinine for kidney function-based risk[J]. N Engl J Med, 2013, 369( 25): 2459. DOI: 10.1056/NEJMc1312801. [20] JAQUES DA, SPAHR L, BERRA G, et al. Biomarkers for acute kidney injury in decompensated cirrhosis: A prospective study[J]. Nephrology(Carlton), 2019, 24( 2): 170- 180. DOI: 10.1111/nep.13226. [21] YE L, LI YZ, PENG JC, et al. Significance of combined detection of serum Cys-C and α1-MG in diagnosis of early hepatorenal syndrome[J]. Med. Inf, 2022, 35( 16): 67- 69. DOI: 10.3969/j.issn.1006-1959.2022.16.014.叶亮, 李运泽, 彭继承, 等. 血清Cys-C、α1-MG联合检测在早期肝肾综合征诊断中的意义[J]. 医学信息, 2022, 35( 16): 67- 69. DOI: 10.3969/j.issn.1006-1959.2022.16.014. [22] GHARAIBEH KA, HAMADAH AM, EL-ZOGHBY ZM, et al. Cystatin C predicts renal recovery earlier than creatinine among patients with acute kidney injury[J]. Kidney Int Rep, 2018, 3( 2): 337- 342. DOI: 10.1016/j.ekir.2017.10.012. [23] INKER LA, SCHMID CH, TIGHIOUART H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C[J]. N Engl J Med, 2012, 367( 1): 20- 29. DOI: 10.1056/NEJMoa1114248. [24] MISHRA J, MA Q, PRADA A, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury[J]. J Am Soc Nephrol, 2003, 14( 10): 2534- 2543. DOI: 10.1097/01.asn.0000088027.54400.c6. [25] LEE JH, YOON EL, PARK SE, et al. Clinical significance of urinary neutrophil gelatinase-associated lipocalin levels in defining the various etiologies of acute kidney injury in liver cirrhosis patients[J]. Korean J Gastroenterol, 2019, 74( 4): 212- 218. DOI: 10.4166/kjg.2019.74.4.212. [26] HAASE M, BELLOMO R, DEVARAJAN P, et al. Accuracy of neutrophil gelatinase-associated lipocalin(NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis[J]. Am J Kidney Dis, 2009, 54( 6): 1012- 1024. DOI: 10.1053/j.ajkd.2009.07.020. [27] ALLEGRETTI AS, PARADA XV, ENDRES P, et al. Urinary NGAL as a diagnostic and prognostic marker for acute kidney injury in cirrhosis: A prospective study[J]. Clin Transl Gastroenterol, 2021, 12( 5): e00359. DOI: 10.14309/ctg.0000000000000359. [28] HUELIN P, SOLÀ E, ELIA C, et al. Neutrophil gelatinase-associated lipocalin for assessment of acute kidney injury in cirrhosis: a prospective study[J]. Hepatology, 2019, 70( 1): 319- 333. DOI: 10.1002/hep.30592. [29] DUAN Z, JIANG M, HUANG X, et al. Urinary neutrophil gelatinase-associated lipocalin can predict the efficacy of volume expansion therapy in patients with hepatitis B cirrhosis and AKI[J]. Front Pharmacol, 2022, 13: 839250. DOI: 10.3389/fphar.2022.839250. [30] ARIZA X, SOLÀ E, ELIA C, et al. Analysis of a urinary biomarker panel for clinical outcomes assessment in cirrhosis[J]. PLoS One, 2015, 10( 6): e0128145. DOI: 10.1371/journal.pone.0128145. [31] BELCHER JM, SANYAL AJ, PEIXOTO AJ, et al. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury[J]. Hepatology, 2014, 60( 2): 622- 632. DOI: 10.1002/hep.26980. [32] WU H, CRAFT ML, WANG P, et al. IL-18 contributes to renal damage after ischemia-reperfusion[J]. J Am Soc Nephrol, 2008, 19( 12): 2331- 2341. DOI: 10.1681/ASN.2008020170. [33] SOLÉ C, SOLÀ E, HUELIN P, et al. Characterization of inflammatory response in hepatorenal syndrome: Relationship with kidney outcome and survival[J]. Liver Int, 2019, 39( 7): 1246- 1255. DOI: 10.1111/liv.14037. [34] TSAI MH, CHEN YC, YANG CW, et al. Acute renal failure in cirrhotic patients with severe sepsis: value of urinary interleukin-18[J]. J Gastroenterol Hepatol, 2013, 28( 1): 135- 141. DOI: 10.1111/j.1440-1746.2012.07288.x. [35] YAMAMOTO T, NOIRI E, ONO Y, et al. Renal L-type fatty acid——binding protein in acute ischemic injury[J]. J Am Soc Nephrol, 2007, 18( 11): 2894- 2902. DOI: 10.1681/ASN.2007010097. [36] FURUHASHI M, HOTAMISLIGIL GS. Fatty acid-binding proteins: role in metabolic diseases and potential as drug targets[J]. Nat Rev Drug Discov, 2008, 7( 6): 489- 503. DOI: 10.1038/nrd2589. [37] DOI K, NOIRI E, MAEDA-MAMIYA R, et al. Urinary L-type fatty acid-binding protein as a new biomarker of sepsis complicated with acute kidney injury[J]. Crit Care Med, 2010, 38( 10): 2037- 2042. DOI: 10.1097/CCM.0b013e3181eedac0. [38] KARVELLAS CJ, SPEISER JL, TREMBLAY M, et al. Elevated FABP1 serum levels are associated with poorer survival in acetaminophen-induced acute liver failure[J]. Hepatology, 2017, 65( 3): 938- 949. DOI: 10.1002/hep.28945. [39] EGUCHI A, HASEGAWA H, IWASA M, et al. Serum liver-type fatty acid-binding protein is a possible prognostic factor in human chronic liver diseases from chronic hepatitis to liver cirrhosis and hepatocellular carcinoma[J]. Hepatol Commun, 2019, 3( 6): 825- 837. DOI: 10.1002/hep4.1350. [40] HAN WK, BAILLY V, ABICHANDANI R, et al. Kidney Injury Molecule-1(KIM-1): a novel biomarker for human renal proximal tubule injury[J]. Kidney Int, 2002, 62( 1): 237- 244. DOI: 10.1046/j.1523-1755.2002.00433.x. [41] BONVENTRE JV. Kidney injury molecule-1(KIM-1): a urinary biomarker and much more[J]. Nephrol Dial Transplant, 2009, 24( 11): 3265- 3268. DOI: 10.1093/ndt/gfp010. [42] YAP DY, SETO WK, FUNG J, et al. Serum and urinary biomarkers that predict hepatorenal syndrome in patients with advanced cirrhosis[J]. Dig Liver Dis, 2017, 49( 2): 202- 206. DOI: 10.1016/j.dld.2016.11.001. [43] ZHANG CC, HOFFELT D, MERLE U. Urinary cell cycle arrest biomarker[TIMP-2]·[IGFBP7] in patients with hepatorenal syndrome[J]. Biomarkers, 2019, 24( 7): 692- 699. DOI: 10.1080/1354750X.2019.1652347. [44] ILARIA G, KIANOUSH K, RUXANDRA B, et al. Clinical adoption of Nephrocheck® in the early detection of acute kidney injury[J]. Ann Clin Biochem, 2021, 58( 1): 6- 15. DOI: 10.1177/0004563220970032. [45] XIE Y, ANKAWI G, YANG B, et al. Tissue inhibitor metalloproteinase-2(TIMP-2)·IGF-binding protein-7(IGFBP7) levels are associated with adverse outcomes in patients in the intensive care unit with acute kidney injury[J]. Kidney Int, 2019, 95( 6): 1486- 1493. DOI: 10.1016/j.kint.2019.01.020. -

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