Wong W, Liu P, Blendis L, Wong F
Department of Medicine, The Toronto Hospital, University of Toronto, Ontario, Canada.
Am J Med. 1999 Mar;106(3):315-22.
The long-term effects of transjugular intrahepatic portosystemic shunts on renal sodium excretion are not known. We sought to determine these long-term effects, as well as to measure the effects of a sodium load in patients who are free of ascites.
Ten patients with cirrhosis who had been successfully treated with transjugular intrahepatic portosystemic stent shunt for refractory ascites were studied before the shunt and again at 6 and 14 months after the shunt while on a 22 mmol sodium/day diet. At 14 months they were also studied on a 200 mmol sodium/day diet for 7 days without diuretics. Renal sodium handling, central blood volume, neurohumoral factors, and hepatic function were measured.
Sodium balance was negative at 6 months (urinary sodium excretion [mean +/- SD] 51 +/- 11 mmol/day versus 7 +/- 2 mmol/day pre-shunt; P < 0.05), was maintained at 14 months (22 +/- 4 mmol/day; P < 0.05 versus pre-shunt), and was associated with normalization of renin activity and aldosterone levels, but not norepinephrine levels, as well as significantly improved renal hemodynamic measurements. Sodium loading with 200 mmol/day resulted in weight gain associated with increased central blood volume and appropriate renal sodium handling in most but not all patients (urinary sodium excretion 188 +/- 14 mmol/day), despite persistent nonsuppressibility of sympathetic hyperactivity.
In cirrhotic patients with refractory ascites treated with a transjugular intrahepatic portosystemic stent shunt, long-term renal sodium handling is improved. Adequate intravascular filling in ascites-free cirrhotic patients with normal portal pressure permits an improved but not normalized renal response to a sodium load, possibly due to persistently elevated sympathetic activity. Therefore, these patients should increase their sodium intake cautiously.
经颈静脉肝内门体分流术对肾钠排泄的长期影响尚不清楚。我们试图确定这些长期影响，并测量无腹水患者钠负荷的影响。
对10例因难治性腹水成功接受经颈静脉肝内门体支架分流术治疗的肝硬化患者，在分流术前以及分流术后6个月和14个月进行研究，患者采用每日22 mmol钠的饮食。在14个月时，还对他们进行了为期7天的每日200 mmol钠饮食且未使用利尿剂的研究。测量肾钠处理、中心血容量、神经体液因子和肝功能。
6个月时钠平衡为负（尿钠排泄[均值±标准差]为51±11 mmol/天，而分流术前为7±2 mmol/天；P<0.05），14个月时保持平衡（22±4 mmol/天；与分流术前相比P<0.05），且与肾素活性和醛固酮水平正常化相关，但与去甲肾上腺素水平无关，同时肾血流动力学测量值显著改善。每日给予200 mmol钠负荷导致体重增加，与中心血容量增加相关，大多数但并非所有患者的肾钠处理适当（尿钠排泄188±14 mmol/天），尽管交感神经活动持续不可抑制。
在接受经颈静脉肝内门体支架分流术治疗的难治性腹水肝硬化患者中，长期肾钠处理得到改善。门静脉压力正常的无腹水肝硬化患者充足的血管内充盈允许对钠负荷的肾反应得到改善但未恢复正常，这可能是由于交感神经活动持续升高所致。因此，这些患者应谨慎增加钠摄入量。
