Dillon J F, Nolan J, Thomas H, Williams B C, Neilson J M, Bouchier I A, Hayes P C
Liver Research Unit, Royal Infirmary of Edinburgh, UK.
J Hepatol. 1997 Feb;26(2):331-5. doi: 10.1016/s0168-8278(97)80049-9.
BACKGROUND/AIMS: Vagal dysfunction is reported in about 70% of patients with cirrhosis, irrespective of aetiology, as detected by cardiovascular reflex tests. We have previously shown that RR-variability on 24-h ECG is a more sensitive marker of vagal dysfunction in cirrhosis. Angiotensin II inhibits vagal function in animals, and it is elevated in cirrhosis and may be the cause of the vagal dysfunction. Our aim was to observe the effect of captopril on vagal dysfunction in cirrhosis.
Eight patients with cirrhosis (biopsy proven, male two, female six, mean age 54.25) had 24-h ECG RR-variability performed. They then received captopril 25 mg t.d.s. for 48 h. The 24-h ECG was repeated on therapy.
Mean blood pressure remained unchanged: baseline 89.8 +/- 4.8 mmHg (mean +/- sem) versus 91.8 +/- 5.9 mmHg, p = not significant. Median baseline RR-variability was 791 (range 18-5344) counts/24 h and increased in all but one patient, with captopril, to 1548 (56-4824) p = 0.008. Three increased into the normal range.
The vagal dysfunction of cirrhosis is caused by neuromodulation by angiotensin II and is not due to a neuropathy.
背景/目的：心血管反射试验检测显示，约70%的肝硬化患者存在迷走神经功能障碍，且与病因无关。我们之前已表明，24小时心电图RR变异性是肝硬化患者迷走神经功能障碍更敏感的标志物。血管紧张素II在动物中抑制迷走神经功能，其在肝硬化患者中升高，可能是迷走神经功能障碍的原因。我们的目的是观察卡托普利对肝硬化患者迷走神经功能障碍的影响。
8例肝硬化患者（经活检证实，男性2例，女性6例，平均年龄54.25岁）进行了24小时心电图RR变异性检测。然后他们接受卡托普利25毫克，每日3次，共48小时。治疗期间重复进行24小时心电图检测。
平均血压保持不变：基线时为89.8±4.8 mmHg（平均值±标准误），治疗后为91.8±5.9 mmHg，p =无显著性差异。基线RR变异性中位数为791（范围18 - 5344）次/24小时，除1例患者外，所有患者使用卡托普利后均增加至1548（56 - 4824），p = 0.008。3例患者增加至正常范围。
肝硬化患者的迷走神经功能障碍是由血管紧张素II的神经调节引起的，而非神经病变所致。
