Wong F, Massie D, Hsu P, Dudley F
Department of Gastroenterology, Alfred Hospital, Victoria, Australia.
Gastroenterology. 1993 Mar;104(3):869-76. doi: 10.1016/0016-5085(93)91024-c.
Patients with cirrhosis and ascites are especially sensitive to the adverse renal effects of indomethacin-induced inhibition of prostaglandin synthesis. The aim of this study was to determine whether indomethacin affects renal function in patients with well-compensated cirrhosis.
Clearance techniques were used to assess renal hemodynamics and sodium and water homeostasis.
The oral administration of 50 mg of indomethacin to well-compensated patients with alcoholic cirrhosis was followed by a significant decrease in glomerular filtration rate (GFR) and effective renal plasma flow because of a preferential increase in afferent arteriolar tone. Indomethacin was both antidiuretic and antinatriuretic due principally to decreased free water clearance and increased proximal tubular reabsorption of sodium. The acute changes in renal function were not sustained. Patients with a high basal GFR were particularly sensitive to the adverse renal effects of indomethacin.
This study indicates that in patients with well-compensated cirrhosis renal prostaglandins are functionally active and may contribute to the pathogenesis of glomerular hyperfiltration. Nonsteroidal anti-inflammatory drugs should be used with caution in all patients with cirrhosis.
肝硬化腹水患者对吲哚美辛诱导的前列腺素合成抑制所产生的不良肾脏影响尤为敏感。本研究的目的是确定吲哚美辛是否会影响代偿良好的肝硬化患者的肾功能。
采用清除技术评估肾脏血流动力学以及钠和水平衡。
给代偿良好的酒精性肝硬化患者口服50毫克吲哚美辛后，肾小球滤过率（GFR）和有效肾血浆流量显著下降，原因是入球小动脉张力优先增加。吲哚美辛既有抗利尿作用又有抗利钠作用，主要是由于自由水清除率降低和近端肾小管对钠的重吸收增加。肾功能的急性变化未持续。基础GFR高的患者对吲哚美辛的不良肾脏影响尤为敏感。
本研究表明，在代偿良好的肝硬化患者中，肾脏前列腺素具有功能活性，可能有助于肾小球高滤过的发病机制。所有肝硬化患者使用非甾体抗炎药时均应谨慎。
