Wong F, Massie D, Hsu P, Dudley F
Department of Gastroenterology, Alfred Hospital, Prahran, Victoria, Australia.
J Hepatol. 1994 Jul;21(1):64-9. doi: 10.1016/s0168-8278(94)80138-x.
Following the administration of 10 mg of nifedipine to 11 patients with well-compensated alcoholic cirrhosis, there was a significant fall in mean arterial blood pressure, accompanied by an increase in heart rate, presumably due to a significant decrease in systemic vascular resistance. Despite the fall in renal perfusion pressure, there was an increase in the effective renal plasma flow and a significant decrease in renal vascular resistance. The glomerular filtration rate was preserved, suggesting that the decrease in renal vascular resistance was due to a preferential decrease in afferent arteriolar tone. There were no significant changes in the filtered sodium load or the tubular reabsorption of sodium and urinary sodium, and urinary volume did not alter significantly. Although the current study indicates that nifedipine can improve the renal circulation in patients with cirrhosis, the significant effects on the systemic circulation suggest that its potential to reverse the intense renal vasoconstriction that can complicate the clinical course of advanced liver disease is unlikely to be of value in the treatment of the hepatorenal syndrome.
对11例代偿良好的酒精性肝硬化患者给予10毫克硝苯地平后，平均动脉血压显著下降，同时心率增加，这可能是由于全身血管阻力显著降低所致。尽管肾灌注压下降，但有效肾血浆流量增加，肾血管阻力显著降低。肾小球滤过率得以维持，表明肾血管阻力降低是由于入球小动脉张力优先降低所致。滤过钠负荷、肾小管对钠的重吸收及尿钠均无显著变化，尿量也无明显改变。虽然目前的研究表明硝苯地平可改善肝硬化患者的肾循环，但对体循环的显著影响表明，其逆转可使晚期肝病临床病程复杂化的强烈肾血管收缩的潜力在肝肾综合征的治疗中可能并无价值。
