Merkel C, Sacerdoti D, Bolognesi M, Buonamico P, Sticca A, Amodio P, Angeli P, Micotti L, Gatta A
Department of Clinical and Experimental Medicine, University of Padua, Italy.
Eur J Gastroenterol Hepatol. 1999 Nov;11(11):1221-5. doi: 10.1097/00042737-199911000-00006.
To assess the long-term effect of the addition of long-acting nitrates to beta-blockers on liver blood flow and liver metabolic activity in patients with cirrhosis and portal hypertension.
Eleven patients with cirrhosis and portal hypertension were investigated by using hepatic vein catheterization and indocyanine green (ICG) constant infusion on baseline conditions, after 1 month of treatment with nadolol, after 3 months of treatment with nadolol plus isosorbide mononitrate, and (in seven cases) after 1 year of combined treatment.
The hepatic venous pressure gradient decreased significantly after nadolol, and more so after addition of isosorbide mononitrate. Hepatic blood flow, and ICG intrinsic hepatic clearance did not change significantly, although few cases showed an increase or decrease in either parameter. A significant correlation was found between changes in ICG intrinsic hepatic clearance and in hepatic venous pressure gradient (r = 0.62, P = 0.04).
Liver blood flow and liver metabolic activity are not consistently affected by addition of isosorbide mononitrate to nadolol. Substantial decreases in portal pressure may be associated with a decrease in ICG intrinsic hepatic clearance.
评估在肝硬化和门静脉高压患者中，在β受体阻滞剂基础上加用长效硝酸盐对肝脏血流和肝脏代谢活性的长期影响。
对11例肝硬化和门静脉高压患者在基线状态、服用纳多洛尔1个月后、服用纳多洛尔加单硝酸异山梨酯3个月后以及（7例患者）联合治疗1年后，采用肝静脉插管和吲哚菁绿（ICG）持续输注进行研究。
服用纳多洛尔后肝静脉压力梯度显著降低，加用单硝酸异山梨酯后降低更明显。肝血流和ICG肝脏内在清除率虽少数病例在这两个参数中有升高或降低，但未发生显著变化。ICG肝脏内在清除率变化与肝静脉压力梯度变化之间存在显著相关性（r = 0.62，P = 0.04）。
在纳多洛尔基础上加用单硝酸异山梨酯对肝脏血流和肝脏代谢活性的影响并不一致。门静脉压力的显著降低可能与ICG肝脏内在清除率降低有关。
