Gatta A, Angeli P, Caregaro L, Menon F, Sacerdoti D, Merkel C
Department of Clinical Medicine, University of Padua, Italy.
Hepatology. 1991 Aug;14(2):231-6.
It has been hypothesized that the magnitude of proximal sodium reabsorption affects the response to aldosterone antagonists in nonazotemic cirrhotic patients with ascites. To verify this hypothesis, we evaluated intrarenal sodium handling by lithium clearance in 51 nonazotemic ascitic cirrhotic patients and in 23 controls who were maintained on the same low-sodium diet (80 mmol/day). Seven of 51 cirrhotic patients underwent spontaneous diuresis, whereas 44 required diuretic treatment. Treatment was started with spironolactone at a dose of 150 mg once daily. The dose was increased to 300 mg and then to 500 mg once daily if no response ensued. Cirrhotic patients who did not experience ascites mobilization with 500 mg spironolactone were then treated with a combined diuretic regimen that included spironolactone at a fixed dose (500 mg once daily) and furosemide at an initial dose of 50 mg once daily. The dose was increased to 100, 150 and 200 mg once daily if no response was noticed. Response to diuretic treatment was defined as body weight loss greater than 700 gm every 3 days until ascites became clinically undetectable. Nonresponders (43%) to spironolactone showed lower sodium fractional excretion (0.34% +/- 0.28% vs. 0.80% +/- 0.50%; p less than 0.001) because of a lower fractional sodium delivery to the distal tubule (18.2% +/- 5.8% vs. 23.4% +/- 7.2%; p less than 0.025) than responders.(ABSTRACT TRUNCATED AT 250 WORDS)
有假说认为，非氮质血症性肝硬化腹水患者近端钠重吸收的程度会影响其对醛固酮拮抗剂的反应。为验证这一假说，我们通过锂清除率评估了51例非氮质血症性肝硬化腹水患者及23例维持相同低钠饮食（80 mmol/天）的对照者的肾内钠处理情况。51例肝硬化患者中有7例出现自发性利尿，而44例需要利尿剂治疗。治疗起始给予螺内酯，剂量为每日150 mg一次。若没有反应，剂量增至每日300 mg，然后增至每日500 mg。对500 mg螺内酯无腹水消退反应的肝硬化患者，随后采用联合利尿剂方案治疗，该方案包括固定剂量（每日500 mg）的螺内酯和初始剂量为每日50 mg的呋塞米。若未观察到反应，剂量增至每日100、150和200 mg。利尿剂治疗的反应定义为每3天体重减轻超过700 g，直至腹水在临床上无法检测到。螺内酯治疗无反应者（43%）的钠排泄分数较低（0.34%±0.28%对0.80%±0.50%；p<0.001），因为其远端小管的钠输送分数较低（18.2%±5.8%对23.4%±7.2%；p<0.025）。（摘要截断于250字）
