Rector W G, Lewis F, Robertson A D, Everson G T
Department of Medicine, University of Colorado Health Sciences Center, Denver General Hospital 80204.
Hepatology. 1990 Sep;12(3 Pt 1):455-9. doi: 10.1002/hep.1840120302.
The aim of this study was to determine whether liver function and portosystemic shunting are related to renal sodium retention in alcoholic liver disease. Twenty-three studies were performed; 10 patients had ascites. Liver function was assessed from the plasma elimination rates of antipyrine, caffeine and stable isotopes of cholic acid, the latter administered both orally [2,2,4,4-2H] and intravenously [24-13C]. Portosystemic shunt fraction was calculated as the ratio of the intravenous and oral clearances of the isotopes of cholic acid. Portosystemic shunt fraction was similar in patients with and without ascites (61% +/- 16% vs. 64% +/- 11%) and unrelated to urinary sodium excretion in patients with ascites (r = -0.145). Patients with ascites had significantly lower elimination rates of all administered compounds as compared with patients without ascites (antipyrine = 0.012 +/- 0.007 vs. 0.031 +/- 0.016/hr, p less than 0.001; caffeine = 0.014 +/- 0.013 vs. 0.061 +/- 0.041/hr, p less than 0.002; intravenous cholic acid = 1.355 +/- 0.442 vs. 2.284 +/- 0.885/hr, p = 0.005; orally administered cholic acid = 2.178 +/- 0.841 vs. 4.056 +/- 1.837/hr, p = 0.007). However, urinary sodium excretion in patients with ascites was not related to the elimination constants of these compounds (r = 0.360, 0.319, 0.067, -0.073, respectively). Ascites complicating alcoholic liver disease is associated with impaired liver function but not the extent of portosystemic shunting.
本研究的目的是确定肝功能和门体分流是否与酒精性肝病患者的肾钠潴留有关。共进行了23项研究；10例患者有腹水。通过安替比林、咖啡因和胆酸稳定同位素的血浆清除率评估肝功能，胆酸稳定同位素分别经口服[2,2,4,4-2H]和静脉注射[24-13C]给药。门体分流分数计算为胆酸同位素静脉清除率与口服清除率之比。有腹水和无腹水患者的门体分流分数相似（61%±16%对64%±11%），且与腹水患者的尿钠排泄无关（r = -0.145）。与无腹水患者相比，有腹水患者所有给药化合物的清除率均显著降低（安替比林=0.012±0.007对0.031±0.016/小时，p<0.001；咖啡因=0.014±0.013对0.061±0.041/小时，p<0.002；静脉注射胆酸=1.355±0.442对2.284±0.885/小时，p = 0.005；口服胆酸=2.178±0.841对4.056±1.837/小时，p = 0.007）。然而，腹水患者的尿钠排泄与这些化合物的消除常数无关（r分别为0.360、0.319、0.067、-0.073）。酒精性肝病并发腹水与肝功能受损有关，但与门体分流程度无关。
