Sugano S, Kawafune T, Okajima T, Ishii K, Watanabe M, Takamura N
Department of Internal Medicine, Saiseikai Wakakusa Hospital, Yokohama, Japan.
Dig Dis Sci. 1998 Apr;43(4):893-7. doi: 10.1023/a:1018851022316.
The purpose of this study is to determine the hemodynamic effects of spironolactone administration associated with an unrestricted sodium diet (salt 10 g) in patients with compensated cirrhosis and portal hypertension. We studied the hemodynamic changes following eight weeks of administration of either placebo (N = 6) or spironolactone (100 mg/day) (N = 6 Pugh-Child's A and 6 B). No significant changes were observed after the administration of the placebo. Spironolactone induced a significant reduction in the hepatic venous pressure gradient (HVPG) (-10.1 +/- 13.3%, P < 0.05), which was associated with a significant reduction of cardiac output (-11.5 +/- 9.3%, P < 0.01), plasma volume (-8.1 +/- 4.7%, P < 0.01), and wedged hepatic venous pressure (-10.5 +/- 11.6%, P < 0.05). There was no significant change in hepatic blood flow and there was no significant correlation between the change in the HVPG and the change in circulating plasma volume. A decrease in the HVPG greater than 10% was observed in eight of 12 patients (67%), defined as responders, at eight weeks. Six of six (100%) grade A patients and two of six (33%) grade B patients responded. This study demonstrated that spironolactone with an unrestricted sodium diet decreased the HVPG in grade A patients but did not significantly decrease the HVPG in grade B patients.
本研究的目的是确定在代偿期肝硬化和门静脉高压患者中，给予螺内酯并采用无限制钠饮食（盐10克）时的血流动力学效应。我们研究了给予安慰剂（N = 6）或螺内酯（100毫克/天）（N = 6例Pugh-Child A级和6例B级）八周后的血流动力学变化。给予安慰剂后未观察到显著变化。螺内酯使肝静脉压力梯度（HVPG）显著降低（-10.1±13.3%，P < 0.05），这与心输出量显著降低（-11.5±9.3%，P < 0.01）、血浆容量显著降低（-8.1±4.7%，P < 0.01）以及肝静脉楔压显著降低（-10.5±11.6%，P < 0.05）相关。肝血流量无显著变化，且HVPG变化与循环血浆容量变化之间无显著相关性。在八周时，12例患者中有8例（67%）观察到HVPG降低超过10%，定义为反应者。6例A级患者中的6例（100%）和6例B级患者中的2例（33%）有反应。本研究表明，在无限制钠饮食的情况下，螺内酯可降低A级患者的HVPG，但对B级患者的HVPG无显著降低作用。
