Shaw-Stiffel T, Campbell P J, Sole M J, Greig P, Wong P Y, Blendis L M
Department of Medicine, Toronto General Hospital, Ontario, Canada.
Gastroenterology. 1988 Nov;95(5):1332-8. doi: 10.1016/0016-5085(88)90369-1.
To assess the role of renal prostaglandin E2 in the pathogenesis of refractory ascites, in relation to renal sodium handling and circulating levels of vasoconstrictive substances, we studied 12 cirrhotic patients with refractory ascites before and after peritoneovenous shunting. Baseline values for urinary prostaglandin E2 excretion, sodium excretion, and creatinine clearance, as well as serum aldosterone, plasma renin activity, and plasma free norepinephrine, were obtained preoperatively with patients on a sodium- and fluid-restricted diet. Diuretics were also withheld. Similar parameters were measured immediately postoperatively during four consecutive 2-h intervals, then again at 2 wk and 3 mo. In patients with refractory ascites, mean baseline urinary prostaglandin E2 excretion was significantly elevated (2.5 +/- 0.8 pmol/min), compared with that in both normal controls and cirrhotics without ascites (1.3 +/- 0.3 pmol/min). A significant natriuresis occurred immediately postoperatively and persisted at 2 wk and 3 mo. Concomitantly, the elevated levels of preoperative vasoconstrictor substances gradually normalized by 2 wk. Urinary prostaglandin E2 excretion, however, rose transiently in the immediate postoperative period and then fell gradually to within the normal range by 3 mo. Enhanced renal prostaglandin E2 synthesis, therefore, does not play a role in the sustained improvement in sodium homeostasis after peritoneovenous shunting in patients with refractory ascites.
为了评估肾前列腺素E2在顽固性腹水发病机制中的作用，以及其与肾钠处理和血管收缩物质循环水平的关系，我们研究了12例顽固性腹水肝硬化患者在腹腔静脉分流术前和术后的情况。术前，让患者采用限钠限水饮食，停用利尿剂，测定尿前列腺素E2排泄量、钠排泄量、肌酐清除率的基线值，以及血清醛固酮、血浆肾素活性和血浆游离去甲肾上腺素水平。术后在连续4个2小时时间段内立即测量类似参数，然后在术后2周和3个月再次测量。与正常对照组和无腹水的肝硬化患者（1.3±0.3 pmol/min）相比，顽固性腹水患者的平均基线尿前列腺素E2排泄量显著升高（2.5±0.8 pmol/min）。术后立即出现显著的利钠作用，并在2周和3个月时持续存在。同时，术前升高的血管收缩物质水平在2周时逐渐恢复正常。然而，尿前列腺素E2排泄量在术后即刻短暂升高，然后在3个月时逐渐降至正常范围内。因此，肾前列腺素E2合成增强在顽固性腹水患者腹腔静脉分流术后钠稳态的持续改善中不起作用。
