Boyer T D, Zia P, Reynolds T B
Gastroenterology. 1979 Aug;77(2):215-22.
Renal function is known to be abnormal in patients with cirrhosis. Diminished cortical blood flow due to active renal vasoconstriction is present. Renal prostaglandins, potent vasodilators, could be released by the kidney in an attempt to maintain renal blood flow. This possibility was investigated by measuring the effect of indomethacin, an inhibitor of prostaglandin synthetase, in patients with alcoholic liver disease. Administration of indomethacin reduced the effective renal plasma flow (ERPF) and creatinine clearance by 23% and 19%, respectively (P less than 0.001), and increased serum creatinine by 29% (P less than 0.001). The response to indomethacin was variable (fall in ERPF (+)7.8% to (-)67%), but was greatest in patients with ascites. Eighty percent of ascitic patients had a greater than 15% fall in ERPF after administration of indomethacin compared with 20% of nonascitic patients (P less than 0.025). An infusion of prostaglandin A1 in 13 patients corrected the decrease in ERPF and creatinine clearance that had followed the administration of indomethacin. The administration of indomethacin caused a significant fall in plasma renin activity, 8.2 +/- 2.5 to 3.6 +/- 1.4 ng/ml/hr (P less than 0.025). The fall in plasma renin activity occurred when ERPF was depressed maximally, suggesting that endogenous prostaglandins exert more control over renin release than does ERPF. Prostaglandins appear to be an important factor in maintaining renal blood flow in patients with cirrhosis and sodium retention.
已知肝硬化患者存在肾功能异常。由于肾血管主动收缩，肾皮质血流减少。肾前列腺素是强效血管扩张剂，肾脏可能会释放它以维持肾血流。通过测量前列腺素合成酶抑制剂吲哚美辛对酒精性肝病患者的影响来研究这种可能性。给予吲哚美辛后，有效肾血浆流量（ERPF）和肌酐清除率分别降低了23%和19%（P<0.001），血清肌酐升高了29%（P<0.001）。对吲哚美辛的反应存在差异（ERPF下降幅度为+7.8%至-67%），但在腹水患者中最为明显。80%的腹水患者在给予吲哚美辛后ERPF下降超过15%，而非腹水患者中这一比例为20%（P<0.025）。对13名患者输注前列腺素A1纠正了给予吲哚美辛后ERPF和肌酐清除率的下降。给予吲哚美辛导致血浆肾素活性显著下降，从8.2±2.5降至3.6±1.4 ng/ml/hr（P<0.025）。血浆肾素活性下降发生在ERPF最大程度降低时，这表明内源性前列腺素对肾素释放的控制作用比ERPF更强。前列腺素似乎是维持肝硬化患者肾血流和钠潴留的一个重要因素。
