Liu HongQun, Gaskari Seyed Ali, Lee Samuel S
Liver Unit, Department of Medicine, University of Calgary. 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
World J Gastroenterol. 2006 Feb 14;12(6):837-42. doi: 10.3748/wjg.v12.i6.837.
Cardiovascular abnormalities accompany both portal hypertension and cirrhosis. These consist of hyperdynamic circulation, defined as reduced mean arterial pressure and systemic vascular resistance, and increased cardiac output. Despite the baseline increased cardiac output, ventricular inotropic and chronotropic responses to stimuli are blunted, a condition known as cirrhotic cardiomyopathy. Both conditions may play an initiating or aggravating pathogenic role in many of the complications of liver failure or portal hypertension including ascites, variceal bleeding, hepatorenal syndrome and increased postoperative mortality after major surgery or liver transplantation. This review briefly examines the major mechanisms that may underlie these cardiovascular abnormalities, concentrating on nitric oxide, endogenous cannabinoids, central neural activation and adrenergic receptor changes. Future work should address the complex interrelationships between these systems.
心血管异常同时伴随着门静脉高压和肝硬化。这些异常包括高动力循环，其定义为平均动脉压降低和全身血管阻力降低，以及心输出量增加。尽管基线心输出量增加，但心室对刺激的变力性和变时性反应减弱，这种情况称为肝硬化性心肌病。这两种情况可能在肝功能衰竭或门静脉高压的许多并发症中起启动或加重致病作用，包括腹水、静脉曲张出血、肝肾综合征以及大手术或肝移植后术后死亡率增加。本综述简要探讨了这些心血管异常可能的主要潜在机制，重点关注一氧化氮、内源性大麻素、中枢神经激活和肾上腺素能受体变化。未来的研究应关注这些系统之间复杂的相互关系。
