Wong F, Massie D, Colman J, Dudley F
Gastroenterology Department, Alfred Hospital, Prahran, Australia.
Gastroenterology. 1993 Mar;104(3):884-9. doi: 10.1016/0016-5085(93)91026-e.
Peripheral and splanchnic arteriolar tone is often decreased in patients with cirrhosis. The responsible circulating vasodilator(s) would be expected to also lower renal vascular resistance. To examine this possibility we have undertaken a hemodynamic study of the renal circulation in patients with stable, well characterized, compensated cirrhosis and in healthy controls of similar age and sex.
Clearance techniques were used to assess splanchnic and renal hemodynamics and hepatocellular function.
Renal vascular resistance was significantly reduced in the cirrhotic patients (P = 0.048) and was accompanied by a significant (P = 0.014) and proportional (r = -0.45; P = 0.016) increase in glomerular filtration rate. The hepatic extraction of indocyanine green, a measure of functional intrahepatic portasystemic shunts, was the only independent predictor of glomerular filtration rate (r = -0.65; P = 0.002).
The results support the hypothesis that, in patients with cirrhosis, the presence of portasystemic shunts results in an increased delivery of endogenous vasodilator(s) into the systemic circulation where their principal action on the renal circulation is to preferentially decrease afferent arteriolar tone. The resultant glomerular hyperfiltration may contribute to the pathogenesis of cirrhotic glomerulosclerosis.
肝硬化患者的外周和内脏小动脉张力常降低。预期起作用的循环血管舒张剂也会降低肾血管阻力。为检验这种可能性，我们对病情稳定、特征明确、代偿期肝硬化患者及年龄和性别相仿的健康对照者的肾循环进行了血流动力学研究。
采用清除技术评估内脏和肾血流动力学以及肝细胞功能。
肝硬化患者的肾血管阻力显著降低（P = 0.048），同时肾小球滤过率显著升高（P = 0.014）且呈比例增加（r = -0.45；P = 0.016）。吲哚菁绿的肝摄取率是功能性肝内门体分流的一项指标，它是肾小球滤过率的唯一独立预测因子（r = -0.65；P = 0.002）。
结果支持以下假说：在肝硬化患者中，门体分流的存在导致内源性血管舒张剂进入体循环的量增加，其对肾循环的主要作用是优先降低入球小动脉张力。由此产生的肾小球高滤过可能促成肝硬化性肾小球硬化的发病机制。
