Nicholls K M, Shapiro M D, Groves B S, Schrier R W
Kidney Int. 1986 Sep;30(3):417-21. doi: 10.1038/ki.1986.200.
Non-excretor cirrhotic patients, defined by their inability to normally excrete a standard water load, display variable responses to head-out water immersion. The hemodynamic, hormonal, and renal functional status of fifteen such patients were analyzed relative to water excretion during head-out water immersion. Group 1 patients (N = 7) all excreted less than 40% of the water load during immersion, whereas excretion was greater than 40% in all eight patients in Group 2. Group 1 patients, when compared with Group 2, had more ascites, more diuretic resistance, lower serum sodium concentration (125 +/- 2 vs. 130 +/- 1 mEq/liter, P less than 0.05), and more impaired baseline water excretion (12.9 +/- 1.2 vs. 35.9 +/- 5.9% of water load in 5 hr, P less than 0.005). Systemic hemodynamic responses to water immersion were similar in both groups. Glomerular filtration rate and renal plasma flow were significantly more impaired in Group 1 patients (inulin clearance 28 +/- 6 vs. 62 +/- 9 ml/min/1.73 m2, P less than 0.05; para-aminohippurate clearance 212 +/- 35 vs. 357 +/- 37 ml/min, P less than 0.05). Concentrations of plasma vasopressin (1.7 +/- 0.5 vs. 0.8 +/- 0.1 pg/ml, P less than 0.05), renin (8.6 +/- 1.7 vs. 3.8 +/- 0.9 ng/ml/hr, P less than 0.05), aldosterone (82 +/- 14 vs. 39 +/- 10 ng/dl, P less than 0.05) and norepinephrine (1155 +/- 183 vs. 603 +/- 126 pg/ml, P less than 0.05) were all significantly higher in Group 1 than Group 2 patients during water immersion.(ABSTRACT TRUNCATED AT 250 WORDS)
非排泄型肝硬化患者，其定义为无法正常排泄标准水负荷，对头部露出水面的水浸试验呈现出不同的反应。分析了15例此类患者在头部露出水面的水浸试验期间相对于水排泄的血流动力学、激素和肾功能状态。第1组患者（N = 7）在水浸期间均排泄少于40%的水负荷，而第2组的所有8例患者排泄量均大于40%。与第2组相比，第1组患者有更多腹水、更强的利尿抵抗、更低的血清钠浓度（125±2对比130±1毫当量/升，P＜0.05），以及更受损的基础水排泄（5小时内为水负荷的12.9±1.2对比35.9±5.9%，P＜0.005）。两组对水浸的全身血流动力学反应相似。第1组患者的肾小球滤过率和肾血浆流量受损明显更严重（菊粉清除率28±6对比62±9毫升/分钟/1.73平方米，P＜0.05；对氨基马尿酸盐清除率212±35对比357±37毫升/分钟，P＜0.05）。水浸期间，第1组患者的血浆血管加压素（1.7±0.5对比0.8±0.1皮克/毫升，P＜0.05）、肾素（8.6±1.7对比3.8±0.9纳克/毫升/小时，P＜0.05）、醛固酮（82±14对比39±10纳克/分升，P＜0.05）和去甲肾上腺素（1155±183对比603±126皮克/毫升，P＜0.05）浓度均显著高于第2组患者。（摘要截于250字）
