Tajiri K, Miyakawa H, Izumi N, Marumo F, Sato C
Second Department of Internal Medicine, Faculty of Medicine, Tokyo Medical and Dental University, Japan.
Hepatology. 1995 Nov;22(5):1430-5.
To investigate the role of nitric oxide in renal function and hemodynamics in cirrhotic patients with ascites, L-arginine (30 g in 300 mL of distilled water), a substrate for nitric oxide synthase, was infused into six cirrhotic patients with ascites, and the effects were compared with those of saline infusion. Healthy controls (n = 5) were also studied under the same conditions. In the patients, L-arginine infusion significantly decreased systolic and diastolic blood pressures while markedly increasing urinary flow and urinary sodium excretion; no significant changes were seen with saline infusion. In controls, only diastolic blood pressure was decreased by L-arginine infusion, whereas urinary flow and urinary sodium excretion were increased by both L-arginine and saline infusion. In both groups, a similar increase of plasma atrial natriuretic factor (ANF) was seen with L-arginine and saline infusions; endothelin and catecholamines were not affected by either infusion. In both groups, plasma levels of vasopressin were increased by L-arginine infusion. In the cirrhotic patients, urinary excretions of cyclic guanosine monophosphate (cGMP) and nitrates/nitrites (NOx) were significantly increased by L-arginine infusion, whereas no significant changes were seen with saline infusion. In controls, only the excretion of cGMP was increased by L-arginine infusion. In summary, L-arginine infusion induces diuresis and natriuresis accompanied by increased excretions of cGMP and NOx in cirrhotic patients with ascites. This differs from the response in controls, where the increase in urinary sodium excretion is not accompanied by an increase in markers of increased nitric oxide synthesis.
为研究一氧化氮在肝硬化腹水患者肾功能和血流动力学中的作用，将一氧化氮合酶的底物L-精氨酸（30克溶于300毫升蒸馏水中）输注给6例肝硬化腹水患者，并将其效果与输注生理盐水的效果进行比较。还在相同条件下对健康对照者（n = 5）进行了研究。在患者中，输注L-精氨酸可显著降低收缩压和舒张压，同时显著增加尿流量和尿钠排泄；输注生理盐水则未见明显变化。在对照者中，输注L-精氨酸仅使舒张压降低，而L-精氨酸和生理盐水输注均使尿流量和尿钠排泄增加。在两组中，输注L-精氨酸和生理盐水后血浆心房利钠因子（ANF）均有类似升高；内皮素和儿茶酚胺均不受任何一种输注的影响。在两组中，输注L-精氨酸均使血管加压素的血浆水平升高。在肝硬化患者中，输注L-精氨酸可使环磷酸鸟苷（cGMP）和硝酸盐/亚硝酸盐（NOx）的尿排泄显著增加，而输注生理盐水则未见明显变化。在对照者中，输注L-精氨酸仅使cGMP的排泄增加。总之，输注L-精氨酸可在肝硬化腹水患者中诱导利尿和利钠，并伴有cGMP和NOx排泄增加。这与对照者的反应不同，对照者尿钠排泄增加并不伴有一氧化氮合成增加标志物的增加。
