1st Division of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
Liver Int. 2010 Oct;30(9):1371-8. doi: 10.1111/j.1478-3231.2010.02322.x.
Variceal bleeding in cirrhosis can cause liver ischaemia and deteriorate the hyperdynamic state; thus, the effects of vasoconstrictor therapy on liver blood volume (LBV) and thorax blood volume (ThBV) are important.
To evaluate and compare the effects of terlipressin and somatostatin on LBV and ThBV in stable patients with cirrhosis and portal hypertension.
Twenty patients were studied (Child-Pugh class A/B/C: 5/8/7). The radioactivities in the liver region (LRR) and the thorax region (ThRR) by single-head gamma camera technique, as indicators of LBV and ThBV, respectively, and systemic haemodynamics were measured at baseline and after intravenous infusion of 2 mg of terlipressin (n=10) or somatostatin 250 mg/h after an initial bolus of 250 mg (n=10).
LRR and ThRR decreased significantly with increasing severity of cirrhosis. Thirty minutes after terlipressin infusion, LRR and ThRR increased by 7.8 ± 4.4% (NS) and 14 ± 5.3% (P=0.01) compared with baseline values; the increase in ThRR was significantly related to the increase in LRR (r=0.682, P=0.03). In contrast, somatostatin reduced LRR and ThRR by 13.3 ± 6.5% (P=0.07) and 1 ± 4% (NS) respectively. LRR and ThRR increased significantly in the terlipressin group compared with the somatostatin group (P=0.01 and P=0.02 respectively). Terlipressin reduced cardiac output and heart rate (both P=0.01) and increased the mean arterial pressure (MAP) and systemic vascular resistance (P=0.009 and P=0.002 respectively); MAP decreased after somatostatin infusion (P=0.03).
Terlipressin, but not somatostatin, maintains LBV, increases ThBV and improves the hyperdynamic state in cirrhosis. These effects can be beneficial in variceal bleeding, particularly in patients with advanced liver disease.
肝硬化静脉曲张出血可导致肝脏缺血并使高动力状态恶化；因此，血管收缩剂治疗对肝血容量（LBV）和胸血容量（ThBV）的影响非常重要。
评估和比较特利加压素和生长抑素对稳定的肝硬化和门静脉高压患者的 LBV 和 ThBV 的影响。
研究了 20 例患者（Child-Pugh 分级 A/B/C：5/8/7）。使用单探头伽玛相机技术测量肝脏区域放射性（LRR）和胸部区域放射性（ThRR），分别作为 LBV 和 ThBV 的指标，并在静脉输注 2mg 特利加压素（n=10）或生长抑素 250mg/h 后（n=10）静脉注射 250mg 初始推注后测量全身血液动力学。
LRR 和 ThRR 随肝硬化严重程度的增加而显著降低。特利加压素输注 30 分钟后，LRR 和 ThRR 分别增加 7.8±4.4%（无统计学意义）和 14±5.3%（P=0.01），与基线值相比；ThRR 的增加与 LRR 的增加显著相关（r=0.682，P=0.03）。相比之下，生长抑素使 LRR 和 ThRR 分别降低 13.3±6.5%（P=0.07）和 1±4%（无统计学意义）。与生长抑素组相比，特利加压素组的 LRR 和 ThRR 显著增加（P=0.01 和 P=0.02）。特利加压素降低心输出量和心率（均 P=0.01），增加平均动脉压（MAP）和全身血管阻力（P=0.009 和 P=0.002）；生长抑素输注后 MAP 降低（P=0.03）。
特利加压素而非生长抑素可维持 LBV、增加 ThBV 并改善肝硬化的高动力状态。这些作用在静脉曲张出血时可能有益，特别是在晚期肝病患者中。
