Moreau R, Gaudin C, Hadengue A, Braillon A, Roulot D, Bacq Y, Lebrec D
Laboratoire d'Hémodynamique Splanchnique, Unité de Recherches de Physiopathologie Hépatique (INSERM U-24) Clichy, France.
Nephron. 1993;65(3):359-63. doi: 10.1159/000187513.
In patients with cirrhosis and ascites decreased renal blood flow might be related to the severity of liver disease but the relationship between the severity of cirrhosis and renal perfusion has not yet been established. Thus we measured renal, systemic and splanchnic hemodynamics in 63 patients with ascites and in 28 without ascites. When compared to patients without ascites, patients with ascites had lower renal blood flow (1,170 +/- 100 vs. 935 +/- 55 ml/min/1.73 m2; mean +/- SEM, p < 0.05) and renal perfusion pressure (78 +/- 2 vs. 72 +/- 1 mm Hg, p < 0.05 and higher inferior vena cava pressure (6.5 +/- 0.7 vs. 10.7 +/- 0.7 mm Hg, p < 0.05). Patients with ascites had significantly higher serum bilirubin concentrations, hepatic venous pressure gradient and lower serum albumin concentrations, indocyanine green (ICG) extraction than patients without ascites. Renal vascular resistance, glomerular filtration rate, mean arterial pressure, cardiac index and systemic vascular resistance were not significantly different between the two groups. By multiple regression analysis no significant correlation was found between liver tests (i.e., prothrombin time, serum bilirubin and albumin concentrations, ICG extraction), hepatic venous pressure gradient, cardiac index and systemic vascular resistance on the one hand and renal blood flow on the other. No significant correlation was found between glomerular filtration rate and liver tests. In conclusion, in patients with cirrhosis and ascites, renal hypoperfusion is not related to the severity of liver disease.
在肝硬化腹水患者中，肾血流量减少可能与肝脏疾病的严重程度有关，但肝硬化严重程度与肾灌注之间的关系尚未明确。因此，我们测量了63例腹水患者和28例无腹水患者的肾、全身和内脏血流动力学。与无腹水患者相比，腹水患者的肾血流量较低（1,170±100 vs. 935±55 ml/min/1.73 m2；均值±标准误，p<0.05），肾灌注压较低（78±2 vs. 72±1 mmHg，p<0.05），下腔静脉压力较高（6.5±0.7 vs. 10.7±0.7 mmHg，p<0.05）。腹水患者的血清胆红素浓度、肝静脉压力梯度显著高于无腹水患者，血清白蛋白浓度、吲哚菁绿（ICG）摄取率则显著低于无腹水患者。两组之间的肾血管阻力、肾小球滤过率、平均动脉压、心脏指数和全身血管阻力无显著差异。通过多元回归分析，一方面肝脏检查指标（即凝血酶原时间、血清胆红素和白蛋白浓度、ICG摄取率）、肝静脉压力梯度、心脏指数和全身血管阻力与另一方面的肾血流量之间未发现显著相关性。肾小球滤过率与肝脏检查指标之间也未发现显著相关性。总之，在肝硬化腹水患者中，肾灌注不足与肝脏疾病的严重程度无关。
