晚期肝硬化和腹水患者的肾功储备保持良好。

Renal functional reserve is well maintained in patients with advanced liver cirrhosis and ascites.

作者信息

Woitas R P, Flommersfeld S, Stoffel-Wagner B, Schiedermaier P, Brensing K A, Spengler U, Sauerbruch T

机构信息

Dept. of Internal Medicine I, University of Bonn, Bonn, Germany.

出版信息

Scand J Gastroenterol. 2002 Nov;37(11):1321-7. doi: 10.1080/003655202761020614.

DOI:10.1080/003655202761020614

PMID:12465732

Abstract

BACKGROUND

Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) in healthy humans can be induced by amino acid stimulation. The rise in GFR from baseline to maximum is referred to as the renal functional reserve (RFR). Recently, we showed that the RFR is preserved in patients with compensated cirrhosis despite impaired renal function. In the present study, we evaluated RFR in decompensated cirrhotics with ascites.

METHODS

Steady-state inulin- and para-aminohippurate (PAH) clearances were performed at rest and during amino acid infusion in 22 patients with decompensated liver cirrhosis and ascites.

RESULTS

Baseline GFR and ERPF (means +95% confidence intervals) were: GFR 25.2 (21.1-29.2) ml min(-1), ERPF 266.6 (229.7-303.5). Amino acid infusion significantly increased GFR by 67% (38.3-95.8) to 34.6 (29.2-40.0) ml min(-1) (means + (95% confidence intervals), P < 0.001) and ERPF by 29% (11.9-46.3) to 326.3 (274.1-378.5) ml min(-1) (P = 0.002). Renal vascular resistance dropped by 13.4% (3.3-23.5) from 29.4 (24.8-33.9) mmHg ml(-1) min(-1) to 26.4 (22.0-30.7) mmHg ml(-1) min(-1) (P = 0.036). The improved kidney function was accompanied by a decrease in systemic aldosterone levels (P < 0.05).

CONCLUSION

In patients with liver cirrhosis and ascites, amino acid infusion improves kidney function. Trials are warranted to test the long-term effects of amino acid infusions in patients with hepatorenal syndrome.

摘要

背景

氨基酸刺激可诱导健康人的肾小球滤过率（GFR）和有效肾血浆流量（ERPF）升高。GFR从基线升至最大值的升高幅度被称为肾功能储备（RFR）。最近，我们发现尽管肾功能受损，但代偿期肝硬化患者的RFR仍得以保留。在本研究中，我们评估了失代偿期肝硬化腹水患者的RFR。

方法

对22例失代偿期肝硬化腹水患者在静息状态及氨基酸输注期间进行稳态菊粉和对氨基马尿酸（PAH）清除率测定。

结果

基线GFR和ERPF（均值+95%可信区间）分别为：GFR 25.2（21.1 - 29.2）ml·min⁻¹，ERPF 266.6（229.7 - 303.5）。氨基酸输注使GFR显著增加67%（38.3 - 95.8），至34.6（29.2 - 40.0）ml·min⁻¹（均值+（95%可信区间），P < 0.001），使ERPF增加29%（11.9 - 46.3），至326.3（274.1 - 378.5）ml·min⁻¹（P = 0.002）。肾血管阻力从29.4（24.8 - 33.9）mmHg·ml⁻¹·min⁻¹下降13.4%（3.3 - 23.5）至26.4（22.0 - 30.7）mmHg·ml⁻¹·min⁻¹（P = 0.036）。肾功能改善的同时，全身醛固酮水平下降（P < 0.05）。