Rector W G, Everson G T, Robertson A D
Division of Gastroenterology, University of Colorado Health Sciences Center, Denver General Hospital.
J Lab Clin Med. 1994 Feb;123(2):218-24.
Sodium retention is triggered in rats with experimental liver injury at a critical threshold of liver function. We compared liver function and sodium retention in serially studied patients with alcoholic cirrhosis to determine whether a similar threshold exists in human beings. Antipyrine, caffeine, and cholic acid clearance were measured in 35 men with alcoholic liver disease. Nineteen patients were evaluated on two or more occasions; between studies, 28 remained in sodium balance (group NN), six spontaneously developed sodium retention and ascites formation (group NY), and seven spontaneously lost ascites (group YN). A threshold between patients with and without sodium retention did not exist for any of the clearance measurements. Indeed, values overlapped widely between the two groups. Antipyrine and cholate clearance were significantly reduced in patients with sodium retention, but caffeine clearance was similar in the two groups. Antipyrine and caffeine clearance declined significantly between the first and second study in group NY; cholate clearance did not change. No significant differences were observed between studies in group YN. In several patients of this group, liver function worsened as ascites spontaneously resolved. Impaired liver function commonly but not invariably accompanies sodium retention in patients with cirrhosis. A threshold at which sodium retention occurs or resolves does not exist.
在实验性肝损伤大鼠中，当肝功能达到临界阈值时会引发钠潴留。我们对酒精性肝硬化患者进行了系列研究，比较其肝功能和钠潴留情况，以确定人类是否存在类似阈值。对35例酒精性肝病男性患者测定了安替比林、咖啡因和胆酸清除率。19例患者接受了两次或更多次评估；在各次研究期间，28例患者保持钠平衡（NN组），6例自发出现钠潴留和腹水形成（NY组），7例自发消退腹水（YN组）。对于任何一项清除率测定，有钠潴留和无钠潴留患者之间均不存在阈值。实际上，两组之间的值有广泛重叠。钠潴留患者的安替比林和胆酸盐清除率显著降低，但两组的咖啡因清除率相似。NY组在首次和第二次研究之间，安替比林和咖啡因清除率显著下降；胆酸盐清除率未改变。YN组各次研究之间未观察到显著差异。该组的几名患者在腹水自发消退时肝功能恶化。肝硬化患者钠潴留通常伴有肝功能受损，但并非总是如此。不存在钠潴留发生或消退的阈值。
