gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-2007Research ArticleЛЕКЦИИ И ОБЗОРЫLECTURES AND REVIEWSГепаторенальный синдром 1-го и 2-го типа: современное состояние проблемыHepatorenal syndrome of the 1-st and the 2-nd type: state-of-the-artМаммаевС. Н.MammayevS. N.КаримоваА. М.KarimovaA. M.200826112008186413Copyright © Маммаев С.Н., Каримова А.М., 20082008Маммаев С.Н., Каримова А.М.Mammayev S.N., Karimova A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/2007

Цель обзора. Дать новые представления о патогенезе, современных диагностических критериях и подходах к лечению гепаторенального синдрома (ГРС).Основные положения обзора. В последние годы в патогенезе ГРС, помимо «классической гипотезы периферической вазодилатации», рассматривается роль сердечной и надпочечниковой недостаточности. Показано, что у больных с ГРС не наблюдается адекватного усиления активности ренин-­ангиотензин­-альдостероновой системы (РААС) и симпатической нервной системы (СНС), что связывают с развитием при циррозе печени (ЦП) специфической кардиомиопатии. В развитии надпочечниковой недостаточности при ГРС играют роль присоединение тяжелой бактериальной инфекции, активация медиаторов воспалительного ответа и усиление действия эндогенных вазоконстрикторов.В 2005 г. в Сан­Франциско предложены новые диагностические критерии ГРС для пациентов с ЦП, что существенно снижает частоту ложноположительных диагнозов ГРС. В зависимости от тяжести клинических проявлений и прогноза выделяют две формы ГРС.Использование вазоконстрикторов (терлипрессина) в сочетании с альбумином значительно снижает проявления ГРС 1-­го типа и позволяет провести трансплантацию печени (ТП), которая является методом выбора для этой категории больных.Заключение. ГРС является грозным осложнением острых и хронических заболеваний печени. В развитии циркуляторной дисфункции при ГРС, помимо периферической вазодилатации, значительное место отводится сердечной и надпочечниковой недостаточности. Выделены новые диагностические критерии ГРС для больных ЦП. Применение терлипрессина и альбумина повышает выживаемость пациентов с ГРС и позволяет провести ТП.

The aim of review

The aim of review. To present modern concept on pathogenesis, up-to-date diagnostic criteria and approaches to treatment of hepatorenal syndrome (HRS).

Original positions of the review. At the last years in pathogenesis HRS, the role of cardiac and adrenal incompetence is discussed along with «classical hypothesis of peripheral vasodilation». It is shown, that in patients with HRS no adequate enhancement of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) activity is observed, that is related to development of specific cardiomyopathy at liver cirrhosis (LC). In development of adrenal failure at HRS addition of severe bacterial infection, activation of inflammatory mediators and activation of endogenous vasoconstrictors effects play a role. In 2005 in San Francisco new HRS diagnostic criteria for LC patients were proposed, that essentially reduces rate of false-positive HRS diagnostics. In relation to clinical severity and prognosis two HRS forms are defined. Application of vasoconstrictors (terlipressin) in combination to albumin considerably reduces severity of HRS of the 1-st type and allows to carry out liver transplantation (LT) which is a method of choice for these patients.

Conclusion

Conclusion. HRS is dreadful complication of acute and chronic liver diseases. In development of circulatory dysfunction at HRS, besides peripheral vasodilation, cardiac and adrenal failure play a major role. New diagnostic HRS criteria for LC patients are defined. Application of terlipressin and albumin increases survival rate of HRS patients and allows to carry out LT.

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The authors declare that there are no conflicts of interest present.