Sacerdoti D, Merlo A, Merkel C, Zuin R, Gatta A
J Hepatol. 1986;2(2):253-61. doi: 10.1016/s0168-8278(86)80084-8.
Cirrhotic patients frequently show a decrease in renal blood flow and redistribution of the flow from the outer cortex to the juxtamedullary cortex. The cause of the maintenance of juxtamedullary perfusion is not presently known. Prostaglandin E2 (PGE2) has its vasodilating effect on medullary and juxtamedullary vessels where it is synthesized. Therefore, its increased production, frequently shown in cirrhotics, could be responsible for the relative preservation of juxtamedullary blood flow. To verify this hypothesis we examined 13 cirrhotic patients. In these patients we determined mean renal blood flow (MRBF), blood flow in the 1st compartment (ICBF) and in the 2nd compartment (IICBF) with the 133-Xenon washout technique and PGE2 plasma levels in the renal veins (PGE2V). MRBF and ICBF were significantly reduced as compared to control subjects (P less than 0.01); IICBF resulted unaltered. Significant correlation was found between IICBF and PGE2V (P less than 0.01). Our data confirm the decrease in renal blood flow and the redistribution of intrarenal blood flow in cirrhotic patients. The maintenance of IICBF is likely to be a consequence of PGE2 renal production.
肝硬化患者常出现肾血流量减少，血流从肾外皮质重新分布至近髓质皮质。目前尚不清楚维持近髓质灌注的原因。前列腺素E2（PGE2）对其合成部位的髓质和近髓质血管具有血管舒张作用。因此，肝硬化患者中常见的PGE2产量增加，可能是近髓质血流相对得以保留的原因。为验证这一假设，我们检查了13例肝硬化患者。我们用133-氙洗脱技术测定了这些患者的平均肾血流量（MRBF）、第一部分肾血流量（ICBF）和第二部分肾血流量（IICBF），并测定了肾静脉中的PGE2血浆水平（PGE2V）。与对照组相比，MRBF和ICBF显著降低（P<0.01）；IICBF未发生改变。IICBF与PGE2V之间存在显著相关性（P<0.01）。我们的数据证实了肝硬化患者肾血流量减少及肾内血流重新分布。IICBF得以维持可能是肾产生PGE2的结果。
