心腎症候群之病態生理

臨床上常見急性或慢性心臟病患者出現腎衰竭；而在慢性腎臟病患最常見的死亡原因為心血管疾病。因此心臟與腎臟疾病之間存在的相互影響及其中病態生理問題逐漸引起大家的注意。2008年Ronco等學者，根據心臟和腎臟的急性或慢性功能變化可能導致另一器官的急性或慢性器官失調將“心腎症候群（Cardiorenal Syndrome, CRS）區分為五種類型。在心臟病引起腎功能變化方面，傳統上認為是因心臟病導致血行動力學變化導致腎損傷，但近年來之研究，認為腎靜脈壓的增加、腎素血管升壓素醛固酮系統及交感神經系統活性改變、一氧化氮及氧化壓力平衡、發炎反應及細胞內質網壓力等因素亦扮演重要角色。對於慢性腎臟病導致心臟功能缺損，除上述病理變化外，因腎功能衰退產生尿毒性心肌病變、鈣磷不平衡導致血管鈣化及貧血亦扮演重要角色，故本文就心腎症候群的病態生理變化及未來發展提出討論。

關鍵字

心腎症候群；急性心衰竭；急性腎損傷；心腎交互作用；生物標記

並列摘要

Hospitalized patients with acute or chronic cardiac diseases may present with various degrees of kidney dysfunction; furthermore, the most common cause of death was cardiovascular disease in patients with chronic kidney diseases. Thus, there are underlying pathophysiological mechanisms causing the interactions between the heart and kidney disease. The term ”cardio-renal syndrome (CRS)” is emerging as a new disease entity and is generally defined as a group of disorders of the concomitant cardiac and renal dysfunctions in which acute or chronic dysfunction of one organ may induce acute or chronic dysfunction of the other. To address the bidirectional nature of heart-kidney interactions, we presented here a new classification of the CRS with 5 subtypes. About acute or chronic cardio-renal syndrome, traditionally, we considered the hemodynamic change caused by cardiac dysfunction is the major mechanism leading to renal damage; however, recent studies demonstrated that high renal vein pressure, activation of renin-angiotension-aldosterone system and sympathetic nervous system, imbalance of nitric oxide level and oxidative stress, and inflammation may also play an important pathophysiological role. In chronic reno-cardiac syndrome, the pathophysiological mechanisms included the uremic cardiomyopathy, vascular calcification due to calcium and phosphorus imbalance, and anemia. This article reviewed the pathophysiology underlying the heart-kidney interaction of CRS and future perspectives. (J Intern Med Taiwan 2011; 22: 392-400)

並列關鍵字

Cardio-renal syndrome ； Acute heart failure ； Acute kidney injury ； Heart-kidney interaction ； Biomarkers

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心腎症候群之病態生理

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