Piscaglia F, Donati G, Gaiani S, Gramantieri L, Leoni S, Mancini M, Bolondi L
Division of Internal Medicine, Department of Internal Medicine and Gastroenterology, University of Bologna, Azienda S Orsola-Malpighi, via Albertoni 15, 40138 Bologna, Italy.
Dig Liver Dis. 2004 Sep;36(9):594-602. doi: 10.1016/j.dld.2004.04.005.
The action pathways of nitrates are hypothesised to be deranged in cirrhosis.
In order to confirm it, the acute haemodynamic effects of isosorbide-5-mononitrate in cirrhotic patients and controls was investigated.
Nine cirrhotics and nine healthy controls.
Evaluation in the fasting state, 90 min after isosorbide-5-mononitrate or placebo (double-blind on two different days) and then 30 and 120 min after eating a standard meal. Various systemic and splanchnic haemodynamic parameters, including arterial impedance, assessed as Doppler pulsatility index, were measured.
isosorbide-5-mononitrate reduced arterial pressure and increased heart rate and mesenteric pulsatility index both in controls and in cirrhotics, whereas the following parameters behaved differently in the two groups (P < 0.05): hepatic pulsatility index decreased (-9%) and the portal velocity increased (+13%) in controls, whereas hepatic pulsatility increased (+18%) and portal velocity decreased (-18%) in cirrhotics. The two groups presented a similar pattern of changes in most variables under placebo after a meal. In controls, the administration of isosorbide-5-mononitrate blunted the postprandial mesenteric vasodilation and related changes in splanchnic and systemic circulation, expected at 30 min, in comparison to those observed under placebo. In cirrhotics, instead, the postprandial pattern was similar under placebo and isosorbide-5-mononitrate.
The acute administration of isosorbide-5-mononitrate produces different haemodynamic effects in healthy and diseased livers, both in the fasting state and after a meal, consistent with the hypothesis of a deranged response of the intrahepatic microcirculation to nitrates in cirrhosis.
硝酸盐的作用途径被推测在肝硬化中发生紊乱。
为了证实这一点，研究了5-单硝酸异山梨酯对肝硬化患者和对照组的急性血流动力学效应。
9名肝硬化患者和9名健康对照者。
在禁食状态下、服用5-单硝酸异山梨酯或安慰剂后90分钟（在两天内进行双盲），然后在进食标准餐后30分钟和120分钟进行评估。测量了各种全身和内脏血流动力学参数，包括通过多普勒搏动指数评估的动脉阻抗。
5-单硝酸异山梨酯在对照组和肝硬化患者中均降低了动脉压，增加了心率和肠系膜搏动指数，而以下参数在两组中的表现不同（P<0.05）：对照组中肝搏动指数降低（-9%），门静脉速度增加（+13%），而肝硬化患者中肝搏动指数增加（+18%），门静脉速度降低（-18%）。两组在餐后服用安慰剂后，大多数变量呈现相似的变化模式。在对照组中，与安慰剂组相比，服用5-单硝酸异山梨酯减弱了餐后预期在30分钟时出现的肠系膜血管舒张以及内脏和全身循环的相关变化。相反，在肝硬化患者中，安慰剂组和5-单硝酸异山梨酯组的餐后模式相似。
5-单硝酸异山梨酯的急性给药在健康肝脏和患病肝脏中，无论在禁食状态还是餐后，都会产生不同的血流动力学效应，这与肝硬化时肝内微循环对硝酸盐反应紊乱的假设一致。
