Chuang Chiao-Lin, Huang Hui-Chun, Chang Ching-Chih, Lee Fa-Yauh, Wu Jaw-Ching, Lee Jing-Yi, Hsieh Hsian-Guey, Lee Shou-Dong
Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
J Gastroenterol Hepatol. 2015 Jan;30(1):199-207. doi: 10.1111/jgh.12670.
Hypo-perfusion resulting from intense renal vasoconstriction is traditionally contributed to renal dysfunction in advanced liver disease, although cumulative studies demonstrated renal vasodilatation with impaired vascular contractility to endogenous vasoconstrictors in portal hypertension and compensated liver cirrhosis. The pathophysiology of altered renal hemodynamics remains unclear. This study, using a rat model of portal hypertension with superimposed endotoxemia, was designed to delineate the evolution of renal vascular reactivity and vaso-regulatory gene expression during liver disease progression.
Rats were randomized into sham surgery (SHAM) or partial portal vein ligation (PVL). Endotoxemia was induced by intraperitoneal injection of lipopolysaccharide (LPS) on the seventh day following surgery. Isolated kidney perfusion was performed at 0.5 h or 5 h after LPS to evaluate renal vascular response to endothelin-1.
In contrast to impaired vascular contractility of SHAM rats, PVL rats displayed enhanced renal vascular reactivity to endothelin-1 at 5 h following endotoxemia. There were extensive upregulations of inducible nitric oxide synthase in kidney tissues of endotoxemic rats. The changes of renal endothelin receptor type A (ETA ) level paralleled with the changes of renal vascular reactivity in LPS-treated rats. Compared with SHAM rats, PVL rats showed increased renal ETA and phosphorylated extracellular-signal-regulated kinases 1/2 (p-ERK1/2) at 5 h after LPS.
LPS-induced systemic hypotension induces a paradoxical change of renal vascular response to endothelin-1 between SHAM and PVL rats. LPS-induced renal vascular hyperreactivity in PVL rats was associated with upregulation of renal ETA and subsequent activation of ERK1/2 signaling.
传统观点认为,严重肾血管收缩导致的低灌注是晚期肝病患者肾功能障碍的原因,尽管多项研究表明,在门静脉高压和代偿期肝硬化患者中,肾血管存在扩张,且对内源性血管收缩剂的血管收缩功能受损。肾血流动力学改变的病理生理学机制尚不清楚。本研究采用门静脉高压合并内毒素血症的大鼠模型,旨在描绘肝病进展过程中肾血管反应性和血管调节基因表达的演变。
将大鼠随机分为假手术组(SHAM)或部分门静脉结扎组(PVL)。术后第7天腹腔注射脂多糖(LPS)诱导内毒素血症。在注射LPS后0.5小时或5小时进行离体肾脏灌注,以评估肾血管对内皮素-1的反应。
与SHAM大鼠血管收缩功能受损不同,PVL大鼠在内毒素血症后5小时对内皮素-1的肾血管反应性增强。内毒素血症大鼠肾组织中诱导型一氧化氮合酶广泛上调。内毒素血症大鼠肾组织中A型内皮素受体(ETA)水平的变化与肾血管反应性的变化平行。与SHAM大鼠相比,PVL大鼠在注射LPS后5小时肾组织中ETA和磷酸化细胞外信号调节激酶1/2(p-ERK1/2)水平升高。
LPS诱导的全身低血压导致SHAM和PVL大鼠对内皮素-1的肾血管反应出现矛盾性变化。PVL大鼠中LPS诱导的肾血管高反应性与肾组织中ETA上调及随后ERK1/2信号通路激活有关。