Møller Søren, Bendtsen Flemming, Henriksen Jens H
Department of Clinical Physiology, University of Copenhagen, Denmark.
Scand J Gastroenterol. 2006 Apr;41(4):451-8. doi: 10.1080/00365520500292962.
Several studies have shown activation of the renin-angiotensin-aldosterone system (RAAS) in cirrhosis. Although the activated RAAS may have several determinants, the system is often considered a surrogate marker of effective hypovolaemia. In this study we investigated the activity of the RAAS and its potential determinants with special focus on the central and arterial blood volume (CBV).
Eighty-nine patients (Child class A/B/C: 19/41/29) and 32 controls were included in the study. All were given a haemodynamic examination with measurement of determinants of the RAAS, including the CBV. Circulating plasma renin concentrations were measured using an immunoradiometric assay.
Arterial renin concentrations were significantly higher in the patients than in the controls (p < 0.003). Plasma renin correlated significantly with several indicators of liver dysfunction and splanchnic and systemic haemodynamics (r = - 0.56-0.55), but only weakly with CBV (r = - 0.25, p < 0.02). In a multivariate regression analysis, plasma renin was determined by serum sodium, alkaline phosphatases and systolic blood pressure (p < 0.04 to p < 0.001).
CBV correlates weakly with circulating renin, and activation of the RAAS can therefore only partly be considered as an indicator of central hypovolaemia. Mechanisms other than central hypovolaemia relating to the liver disease and portal hypertension contribute significantly to the RAAS activation.
多项研究表明肝硬化患者肾素-血管紧张素-醛固酮系统（RAAS）被激活。尽管激活的RAAS可能有多种决定因素，但该系统常被视为有效血容量不足的替代标志物。在本研究中，我们调查了RAAS的活性及其潜在决定因素，特别关注中心血容量和动脉血容量（CBV）。
本研究纳入了89例患者（Child分级A/B/C级：19/41/29例）和32例对照者。所有受试者均接受血流动力学检查，测量包括CBV在内的RAAS决定因素。采用免疫放射分析法测定循环血浆肾素浓度。
患者的动脉肾素浓度显著高于对照者（p < 0.003）。血浆肾素与肝功能不全、内脏和全身血流动力学的多项指标显著相关（r = - 0.56 - 0.55），但与CBV的相关性较弱（r = - 0.25，p < 0.02）。在多变量回归分析中，血浆肾素由血清钠、碱性磷酸酶和收缩压决定（p < 0.04至p < 0.001）。
CBV与循环肾素的相关性较弱，因此RAAS的激活只能部分被视为中心血容量不足的指标。与肝脏疾病和门静脉高压相关的除中心血容量不足之外的机制对RAAS激活有显著影响。
