Rector W G, Lewis F W, Adair O V, Robertson A D
Division of Gastroenterology, University of Colorado Health Sciences Center, Denver 80205.
Am J Med. 1992 May;92(5):485-93. doi: 10.1016/0002-9343(92)90745-w.
The relationship of plasma renin activity (PRA) to indices of circulatory filling and other possible determinants of renin secretion was studied in 31 men with alcoholic liver disease. Characteristics of patients with normal and increased PRA values were examined. Significant differences guided subsequent simple and multiple regression analysis.
Supine PRA was increased (greater than 2.4 ng/mL/h on a 200 mEq/d intake of sodium, ranging as high as 33 ng/mL/h) in 14 of 57 studies. Nonascitic patients with elevated PRA values were significantly younger than those with normal PRA values. Among patients without ascites, the plasma atrial natriuretic factor concentration correlated inversely with PRA. Ascitic patients with elevated PRA values had a significantly reduced serum sodium concentration, urinary sodium excretion, creatinine clearance, and arterial pressure. Systemic vascular resistance, plasma norepinephrine and caffeine concentrations, and left atrial volume were similar in patients with and without increased PRA values. Univariate followed by multiple regression analysis identified age and plasma atrial natriuretic factor concentration as significant independent correlates of PRA in patients without ascites (R2 = 0.54). Serum sodium concentration and urinary sodium excretion were significant correlates of PRA in patients with ascites (R2 = 0.80).
The associates of PRA in alcoholic liver disease are diverse and potentially complex. Age and plasma atrial natriuretic factor concentration are important in patients without ascites. In patients with ascites, tubular delivery of sodium to the macula densa, as modified by the filtered load and proximal reabsorption, appeared to be a principal association of PRA. Indices of circulatory filling did not emerge as clearly independent associations of PRA. Increased PRA values in patients with ascites may be an effect of sodium retention rather than part of its cause.
目的、患者及方法：对31例酒精性肝病男性患者研究了血浆肾素活性（PRA）与循环充盈指标及其他可能的肾素分泌决定因素之间的关系。对PRA值正常和升高的患者特征进行了检查。显著差异指导了后续的单因素和多因素回归分析。
在57项研究中的14项中，仰卧位PRA升高（钠摄入量为200 mEq/d时大于2.4 ng/mL/h，高达33 ng/mL/h）。PRA值升高的非腹水患者明显比PRA值正常的患者年轻。在无腹水的患者中，血浆心钠素浓度与PRA呈负相关。PRA值升高的腹水患者血清钠浓度、尿钠排泄、肌酐清除率和动脉压显著降低。PRA值升高和未升高的患者全身血管阻力、血浆去甲肾上腺素和咖啡因浓度以及左心房容积相似。单因素随后进行多因素回归分析确定年龄和血浆心钠素浓度是无腹水患者PRA的显著独立相关因素（R2 = 0.54）。血清钠浓度和尿钠排泄是腹水患者PRA的显著相关因素（R2 =
0.80）。
酒精性肝病中PRA的相关因素多样且可能复杂。年龄和血浆心钠素浓度在无腹水患者中很重要。在腹水患者中，经滤过负荷和近端重吸收调节后，向致密斑的钠肾小管输送似乎是PRA的主要相关因素。循环充盈指标并未明显成为PRA的独立相关因素。腹水患者PRA值升高可能是钠潴留的结果而非其部分原因。
