Merkel C, Gatta A, Milani L, Amodio P, Zuin R
Scand J Gastroenterol. 1981;16(6):775-80. doi: 10.3109/00365528109181003.
The pathogenesis of renal functional impairment in patients with cirrhosis is still poorly understood, although it is probably linked to intrarenal haemodynamic alterations, such as renal cortical vasoconstriction and opening of intrarenal shunts. To elucidate the intrarenal haemodynamic pattern in patients with cirrhosis, in eight patients with this disease mean renal blood flow (MRBF) and cortical blood flow (CBF) were determined by means of the xenon-133 washout technique; in the same subjects mean intrarenal circulation time for plasma (t) and fastest circulation time for plasma(t0) were determined by means of injection of human serum albumin tagged with technetium-99m into the renal artery. Moreover, cortical vascular volume (CVV) was obtained in all subjects by means of the following formula: CVV = CBF x t. Fourteen normal subjects constituted a control group for MRBF, 9 subjects for CBF, and 4 subjects for t, t0, and CVV. In patients with cirrhosis MRBF and CBF were significantly less than in controls; t did not show any significant alterations, whereas t0 was significantly shorter than in controls. CVV was also significantly impaired. It is concluded that renal cortical vasoconstriction is a characteristic of the renal haemodynamic pattern in patients with cirrhosis. It is suggested that the decrease in t0 is due to the opening of intrarenal shunts and that is likely to be the consequence of renal vasoconstriction.
肝硬化患者肾功能损害的发病机制仍未完全明确，尽管其可能与肾内血流动力学改变有关，如肾皮质血管收缩和肾内分流开放。为阐明肝硬化患者的肾内血流动力学模式，对8例肝硬化患者采用氙-133洗脱技术测定平均肾血流量（MRBF）和皮质血流量（CBF）；对同一组受试者通过向肾动脉注射锝-99m标记的人血清白蛋白来测定平均肾内血浆循环时间（t）和最快血浆循环时间（t0）。此外，通过以下公式计算所有受试者的皮质血管容量（CVV）：CVV = CBF × t。14名正常受试者作为MRBF的对照组，9名作为CBF的对照组，4名作为t、t0和CVV的对照组。肝硬化患者的MRBF和CBF显著低于对照组；t无显著变化，而t0显著短于对照组。CVV也显著受损。结论是肾皮质血管收缩是肝硬化患者肾血流动力学模式的一个特征。提示t0缩短是由于肾内分流开放，这可能是肾血管收缩的结果。
