Sitges-Serra A, Carulla X, Piera C, Martínez-Ródenas F, Franch G, Pereira J, Gubern J M
Department of Surgery, Hospital Universitari del Mar, Autonomous University of Barcelona, Spain.
Br J Surg. 1992 Jun;79(6):553-6. doi: 10.1002/bjs.1800790626.
To elucidate the pathogenesis of renal dysfunction associated with obstructive jaundice, body water compartments were measured using a multi-isotope dilution technique in ten patients with biliary tract obstruction and in ten control subjects matched for age, sex, weight, height and body surface area. Expressed as a fraction of body-weight, total body water was reduced in jaundiced patients (41.8 versus 46.2 per cent, P less than 0.02). Extracellular water volume was also reduced in patients with jaundice (20.3 versus 24.3 per cent, P less than 0.003) owing to a reduction of the interstitial space (16.1 versus 19.5 per cent, P less than 0.004) and, to a lesser degree, of the plasma volume (4.2 versus 4.8 per cent, P = 0.1). There was a close correlation in jaundiced patients between plasma volume and the creatinine clearance rate (r2 = 0.56, P less than 0.02) and between plasma volume and extracellular volume (r2 = 0.77, P less than 0.0001). Extracellular volume in such patients also correlated with the percentage weight loss (r2 = 0.42, P = 0.04). Obstructive jaundice is associated with a contracted extracellular water compartment, although extracellular water, as a percentage of body-weight, increased in proportion to the body-weight lost. Reduction of the interstitial volume and a marginally reduced plasma volume may be determinant factors in the pathogenesis of the renal and haemodynamic disturbances observed in patients with biliary tract obstruction.
为阐明与梗阻性黄疸相关的肾功能不全的发病机制，采用多同位素稀释技术对10例胆道梗阻患者和10例年龄、性别、体重、身高及体表面积相匹配的对照者进行了人体水腔室测量。以体重的百分比表示，黄疸患者的总体水减少（41.8%对46.2%，P<0.02）。黄疸患者的细胞外液量也减少（20.3%对24.3%，P<0.003），这是由于间质间隙减少（16.1%对19.5%，P<0.004），以及血浆量在较小程度上减少（4.2%对4.8%，P=0.1）。黄疸患者的血浆量与肌酐清除率之间存在密切相关性（r2=0.56，P<0.02），血浆量与细胞外液量之间也存在密切相关性（r2=0.77，P<0.0001）。此类患者的细胞外液量还与体重减轻百分比相关（r2=0.42，P=0.04）。梗阻性黄疸与细胞外水腔室缩小有关，尽管以体重百分比表示的细胞外水与体重减轻成比例增加。间质体积减少和血浆量略有减少可能是胆道梗阻患者观察到的肾脏和血流动力学紊乱发病机制中的决定性因素。
