Henriksen J H, Fuglsang S, Bendtsen F, Møller S
Department of Clinical Physiology and Nuclear Medicine, 239, Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark.
Gut. 2006 Mar;55(3):380-7. doi: 10.1136/gut.2005.064329.
Arterial hypertension is a common disorder. Hyperkinetic circulation and reduced effective volaemia are central elements in the haemodynamic dysfunction in cirrhosis. The aim of the present study was to investigate whether cirrhotic patients with arterial hypertension are normokinetic and normovolaemic or whether they reveal the same circulatory dysfunction as their normotensive counterparts.
Thirty three patients with arterial hypertension were identified among 648 patients with cirrhosis: 14 in Child class A, 12 in class B, and seven in class C. Controls were 130 normotensive cirrhotic patients, 19 controls with normal arterial blood pressure and without liver disease, and 16 patients with essential arterial hypertension. All groups underwent haemodynamic investigation with determination of cardiac output (CO), plasma volume (PV), central blood volume (CBV), hepatic venous pressure gradient (HVPG), hepatic blood flow (HBF), arterial compliance (AC), and systemic vascular resistance (SVR) in the supine position.
Liver function, as evaluated by galactose elimination capacity, indocyanine green clearance, HBF, and Child score, was significantly better in hypertensive cirrhotics than in their normotensive counterparts (p<0.05-0.01) but portal pressure was similar (HVPG 13 v 15 mm Hg; NS). AC was significantly lower and normal in the arterial hypertensive cirrhotic group (1.07 v 1.39 mm Hg/ml; p<0.02) and SVR was significantly higher and normal (1475 v 1020 dynxs/cm5; p<0.01). Arterial hypertensive cirrhotic patients were hyperdynamic (CO 6.80 v 7.14 l/min; NS) and central hypovolaemic (CBV 19.8 v 20.6 ml/kg; NS), as were normotensive patients, but differences were found in relation to arterial blood pressure. Whereas arterial pressure was inversely correlated with CO, PV, and Child score in the normotensive group (p< 0.01), the same correlations were either direct or insignificant in arterial hypertensive cirrhotics.
Arterial hypertensive cirrhotic patients are hyperkinetic and central hypovolaemic, in common with their normotensive counterparts, but vasodilatation is reduced and regulation of arterial blood pressure may be less deranged.
动脉高血压是一种常见疾病。高动力循环和有效血容量减少是肝硬化血流动力学功能障碍的核心因素。本研究的目的是调查患有动脉高血压的肝硬化患者是否具有正常的血流动力学和正常血容量，或者他们是否表现出与血压正常的肝硬化患者相同的循环功能障碍。
在648例肝硬化患者中确定了33例动脉高血压患者：Child A级14例，B级12例，C级7例。对照组包括130例血压正常的肝硬化患者、19例动脉血压正常且无肝脏疾病的对照者以及16例原发性动脉高血压患者。所有组均接受了血流动力学检查，测定了仰卧位的心输出量（CO）、血浆容量（PV）、中心血容量（CBV）、肝静脉压力梯度（HVPG）、肝血流量（HBF）、动脉顺应性（AC）和全身血管阻力（SVR）。
通过半乳糖清除能力、吲哚菁绿清除率、HBF和Child评分评估的肝功能，高血压肝硬化患者明显优于血压正常的肝硬化患者（p<0.05 - 0.01），但门静脉压力相似（HVPG分别为13和15 mmHg；无显著性差异）。动脉高血压肝硬化组的AC显著降低且正常（1.07 vs 1.39 mmHg/ml；p<0.02），SVR显著升高且正常（1475 vs 1020 dynxs/cm5；p<0.01）。动脉高血压肝硬化患者与血压正常的患者一样具有高动力性（CO分别为6.80和7.14 l/min；无显著性差异）和中心血容量减少（CBV分别为19.8和20.6 ml/kg；无显著性差异），但在动脉血压方面存在差异。在血压正常组中，动脉压与CO、PV和Child评分呈负相关（p<0.01），而在动脉高血压肝硬化患者中，相同的相关性要么是正相关，要么无显著性差异。
动脉高血压肝硬化患者与血压正常的患者一样具有高动力性和中心血容量减少，但血管舒张功能降低，动脉血压调节可能较少紊乱。
