Guarner F, Hughes R D, Gimson A E, Williams R
Liver Unit, King's College Hospital, London.
Gut. 1987 Dec;28(12):1643-7. doi: 10.1136/gut.28.12.1643.
Eighteen patients with fulminant liver failure were studied, 10 with normal renal function (group A) and eight with renal failure (group B, plasma creatinine greater than 200 mumol/l). Renal function was assessed by standard clearance techniques and patients in group B had a marked reduction compared with group A in both renal plasma flow and glomerular filtration rate. Raised plasma renin activity was observed in both groups, but levels in group B were significantly higher than in group A. Renal prostacyclin production was estimated by radioimmunoassay (RIA) of 6-keto-prostaglandin F1 alpha in urine, and the excretion rate was markedly increased in group A as compared with nine healthy controls, but was low in group B. The plasma concentrations of 6-keto-prostaglandin F1 alpha and thromboxane B2 were similar in groups A and B and were both significantly higher than in controls. Haemodynamic measurements showed a high cardiac output with low vascular resistance and mean arterial pressure within normal limits in both groups. The pulse pressure, however, was significantly higher in group B than in group A. In conclusion, patients in FHF with renal failure have marked renal vasoconstriction with increased plasma renin activity and reduced renal prostaglandin excretion indicative of an imbalance between vasoactive forces.
对18例暴发性肝衰竭患者进行了研究，其中10例肾功能正常（A组），8例肾衰竭（B组，血浆肌酐大于200μmol/l）。采用标准清除技术评估肾功能，B组患者的肾血浆流量和肾小球滤过率与A组相比均显著降低。两组均观察到血浆肾素活性升高，但B组水平显著高于A组。通过放射免疫分析法（RIA）检测尿中6-酮-前列腺素F1α来估计肾前列环素的生成，与9名健康对照相比，A组的排泄率显著增加，但B组较低。A组和B组的6-酮-前列腺素F1α和血栓素B2血浆浓度相似，且均显著高于对照组。血流动力学测量显示两组心输出量高，血管阻力低，平均动脉压在正常范围内。然而，B组的脉压显著高于A组。总之，暴发性肝衰竭合并肾衰竭的患者存在明显的肾血管收缩，血浆肾素活性增加，肾前列腺素排泄减少，表明血管活性力量之间失衡。
