心腎症候群及其處置

Cardiorenal Syndrome and Management

范佩君(Pei-Chun Fan) ； 張智翔(Chih-Hsiang Chang) ； 陳永昌(Yung-Chang Chen)

《內科學誌》 25卷2期 (2014/04) Pp. 65-70

https://doi.org/10.6314/JIMT.2014.25(2).01

摘要

近年來「器官交談」的概念漸受重視，「心腎症候群」即是最佳的例子。心腎症候群的定義為「心臟或腎臟的急性或慢性功能障礙，導致另外一個器官急性或慢性的功能障礙」，根據原發器官不同，以及疾病進程的急性或慢性，可分為五種亞型。其致病機轉十分複雜且尚未被完全了解，目前已知包含血行動力學改變、交感神經及內分泌系統活化、免疫發炎反應和氧化壓力、內皮功能障礙、貧血等，另外腎衰竭引致毒素堆積、電解質酸鹼異常、礦物質和骨代謝異常也扮演重要的角色。治療方面，除了傳統針對心衰竭、腎衰竭支持或替代療法，隨著對病生理機轉漸漸了解，有越來越多新興的療法值得期待。

關鍵字

心腎症候群（Cardiorenal syndrome） ； 心衰竭（Heart failure） ； 急性腎損傷（Acute kidney injury） ； 慢性腎臟病（Chronic kidney disease）

並列摘要

In recent decades, the idea of ＂organ cross-talk＂ has been increasingly appreciated in human diseases, with cardiorenal syndrome being a typical example. The cardiorenal syndrome is defined as ＂disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other＂. In terms of the primary dysfunctional organ and the time-frame, it is further divided into five subtypes. The pathophysiology of cardiorenal syndrome is extremely complex and has not been fully understood. The scenario of cardiorenal syndrome involves hemodynamic alterations, sympathetic nervous system activation, renin-angiotensin-aldosterone system activation, inflammation reaction and oxidative stress, endothelial dysfunction, anemia, etc. Meanwhile, renal failure related uremic toxins, electrolyte imbalance, acidosis, mineral-bone-disease also play important roles. Aside from traditional therapy for heart failure, known supportive treatment for renal failure or renal replacement therapy, novel therapies are being developed targeting underlying pathologies.