García-Pagán J C, Salmerón J M, Feu F, Luca A, Ginés P, Pizcueta P, Claria J, Piera C, Arroyo V, Bosch J
Liver Unit, Hospital Clinic and Provincial, University of Barcelona, Spain.
Hepatology. 1994 May;19(5):1095-9. doi: 10.1002/hep.1840190506.
The aim of this study was to investigate the hemodynamic effects of spironolactone associated with a low-sodium diet (n = 14) or a low-sodium diet alone (n = 9) in patients with compensated cirrhosis and portal hypertension. Spironolactone significantly reduced the plasma volume. This effect was associated with a significant reduction in the hepatic venous pressure gradient, from 17.6 +/- 3.6 mm Hg to 15.3 +/- 3.5 mm Hg (-13% +/- 13%; p < 0.01). Azygos blood flow (-20% +/- 20%), cardiac output (-16.2% +/- 10.5%) and mean arterial pressure (-9% +/- 9%) also decreased significantly. However, there were no significant changes in hepatic blood flow. Patients receiving low-sodium diet alone experienced a mild but significant reduction in hepatic venous pressure gradient (-6.3% +/- 6%) and in mean arterial pressure (-4% +/- 5%). There were no significant changes in cardiac output and in hepatic or azygos blood flows. This study indicates that low-sodium diet plus administration of spironolactone reduces portal pressure and azygos blood flow in patients with compensated cirrhosis. Low-sodium diet alone only produces mild effects that are likely to be clinically irrelevant.
本研究旨在探讨螺内酯联合低钠饮食（n = 14）或单纯低钠饮食（n = 9）对代偿期肝硬化和门静脉高压患者的血流动力学影响。螺内酯显著降低血浆容量。这一效应与肝静脉压力梯度显著降低相关，从17.6±3.6 mmHg降至15.3±3.5 mmHg（-13%±13%；p<0.01）。奇静脉血流量（-20%±20%）、心输出量（-16.2%±10.5%）和平均动脉压（-9%±9%）也显著降低。然而，肝血流量无显著变化。单纯接受低钠饮食的患者肝静脉压力梯度（-6.3%±6%）和平均动脉压（-4%±5%）有轻度但显著的降低。心输出量以及肝血流或奇静脉血流无显著变化。本研究表明，低钠饮食加用螺内酯可降低代偿期肝硬化患者的门静脉压力和奇静脉血流量。单纯低钠饮食仅产生可能在临床上无意义的轻微影响。
