Wong F, Logan A, Blendis L
Department of Medicine, Toronto Hospital, Ont.
Clin Invest Med. 1996 Jun;19(3):184-94.
To assess, in patients with well-compensated pre-ascitic cirrhosis, (1) the extent of vasodilatation, if any, in the forearm circulation and (2) the effect of sodium status on its response to reflex sympathetic stimulation.
Case-control study.
Clinical investigation unit of the Toronto Hospital, a tertiary referral hospital.
Eight male, alcoholic patients with pre-ascitic cirrhosis and 10 age- and sex-matched controls.
Patients and controls were given a diet containing 20 mmol of sodium per day for 7 days, then a diet containing 200 mmol of sodium per day for the subsequent 7 days. On the seventh day of each diet, systemic hemodynamics, forearm circulation and effective arterial blood volume were assessed. A cold pressor test was performed after both diets to assess the response of the forearm circulation to reflex sympathetic stimulation.
Heart rate, mean arterial pressure, forearm blood flow, forearm vascular resistance, central venous pressure, atrial natriuretic factor concentrations and neurohumoral pressor levels (plasma renin activity, aldosterone and plasma norepinephrine levels).
No forearm vasodilatation was evident in the patients with pre-ascitic cirrhosis; their forearm blood flow and forearm vascular resistance were similar to those of the controls. Sodium loading did not influence baseline forearm blood flow. Cold pressor stimulus resulted in a significant decrease in forearm blood flow and a significant increase in forearm vascular resistance, mean arterial pressure, heart rate and plasma norepinephrine levels in both groups after the low-sodium diet. High sodium intake resulted in significantly greater reduction in forearm blood flow (-19%, standard error of the mean [SEM] 3% v. -8%, SEM 3%; p < 0.05) and significantly greater increase in forearm vascular resistance (+46%, SEM 7% v. +25%, SEM 8%; p < 0.05) in the patients with cirrhosis than in the controls.
Well-compensated pre-ascitic cirrhotic patients do not have forearm vasodilatation. Sodium loading does not increase baseline forearm blood flow in these patients, but it does lead to a heightened response to reflex sympathetic stimulation. Sodium loading, with the associated sympathetic hyper-responsiveness, may therefore contribute to further sodium retention in these patients.
评估代偿良好的腹水前期肝硬化患者，（1）前臂循环中血管舒张的程度（若存在），以及（2）钠状态对其对反射性交感神经刺激反应的影响。
病例对照研究。
多伦多医院临床研究室，一家三级转诊医院。
8名男性酒精性腹水前期肝硬化患者以及10名年龄和性别匹配的对照者。
患者和对照者先接受每天含20 mmol钠的饮食7天，随后7天接受每天含200 mmol钠的饮食。在每种饮食的第7天，评估全身血流动力学、前臂循环和有效动脉血容量。在两种饮食后均进行冷加压试验，以评估前臂循环对反射性交感神经刺激的反应。
心率、平均动脉压、前臂血流量、前臂血管阻力、中心静脉压、心房利钠因子浓度和神经体液加压水平（血浆肾素活性、醛固酮和血浆去甲肾上腺素水平）。
腹水前期肝硬化患者前臂无明显血管舒张；其前臂血流量和前臂血管阻力与对照者相似。钠负荷不影响基线前臂血流量。在低钠饮食后，冷加压刺激使两组的前臂血流量显著减少，前臂血管阻力、平均动脉压、心率和血浆去甲肾上腺素水平显著升高。与对照者相比，肝硬化患者高钠摄入导致前臂血流量显著更大幅度降低（-19%，平均标准误[SEM] 3% 对 -8%，SEM 3%；p < 0.05），前臂血管阻力显著更大幅度升高（+46%，SEM 7% 对 +25%，SEM 8%；p < 0.05）。
代偿良好的腹水前期肝硬化患者无前臂血管舒张。钠负荷不会增加这些患者的基线前臂血流量，但会导致对反射性交感神经刺激的反应增强。因此，钠负荷及相关的交感神经高反应性可能导致这些患者进一步钠潴留。
