Ottesen L H, Flyvbjerg A, Møller S, Bendtsen F
Department of Medicine V, Aarhus University Hospital, Centre for Clinical Pharmacology at the University of Aarhus, Denmark.
Aliment Pharmacol Ther. 1998 Jul;12(7):657-65. doi: 10.1046/j.1365-2036.1998.00353.x.
Intravenous octreotide is an established treatment of oesophageal variceal haemorrhage in the cirrhotic patient.
To examine the organ extraction and splanchnic haemodynamic effects of octreotide in cirrhotic patients with portal hypertension.
Thirteen patients with cirrhosis had hepatic venous catheterization performed. Hepatic venous pressure gradient (HVPG), indocyanine green (ICG) clearance and hepatic blood flow (HBF) were determined in the basal state and during 60 min of octreotide infusion by bolus injection (0.75 microg/kg) followed by continuous infusion of 0.75 microg/kg x h. Blood samples were simultaneously drawn from the femoral artery and the hepatic and renal veins.
The extraction fraction of octreotide in the liver was 0.05 (-0.01 - 0.14) (median (interquartile range)) and in the kidneys 0.16 (-0.06 - 0.35). The extraction fraction ratio (E(liver)/E(kidney)) was 0.69 (-0.20 - 1.06). Hepatic clearance was 47 mL/min (3-88) (n = 11). No correlations were found between liver biochemistry or galactose elimination capacity (GEC; a metabolic measure of liver function) and renal extraction fraction or liver clearance. Octreotide had no effect on HVPG or wedged hepatic venous pressure although free hepatic venous pressure increased during octreotide infusion: 6 mmHg (5-9) vs. 7 mmHg (6-10) (P = 0.02). No effect on HBF was observed while ICG clearance decreased significantly.
Octreotide is extracted in cirrhotic patients by both the liver and the kidney, the latter being the most important organ of elimination. Octreotide decreases liver metabolic activity determined by the ICG clearance technique, but no significant effects of octreotide on HVPG or HBF could be demonstrated.
静脉注射奥曲肽是肝硬化患者食管静脉曲张出血的既定治疗方法。
研究奥曲肽对肝硬化门静脉高压患者的器官摄取及内脏血流动力学的影响。
对13例肝硬化患者进行肝静脉插管。在基础状态及奥曲肽输注60分钟期间测定肝静脉压力梯度（HVPG）、吲哚菁绿（ICG）清除率及肝血流量（HBF），奥曲肽先静脉推注（0.75μg/kg），随后以0.75μg/kg×h持续输注。同时从股动脉、肝静脉和肾静脉采集血样。
奥曲肽在肝脏的摄取分数为0.05（-0.01 - 0.14）（中位数（四分位间距）），在肾脏为0.16（-0.06 - 0.35）。摄取分数比（E（肝脏）/E（肾脏））为0.69（-0.20 - 1.06）。肝脏清除率为47 mL/分钟（3 - 88）（n = 11）。未发现肝脏生化指标或半乳糖清除率（GEC；肝功能的一项代谢指标）与肾脏摄取分数或肝脏清除率之间存在相关性。奥曲肽对HVPG或肝静脉楔压无影响，尽管在奥曲肽输注期间游离肝静脉压力升高：6 mmHg（5 - 9）对比7 mmHg（6 - 10）（P = 0.02）。未观察到对HBF有影响，而ICG清除率显著降低。
肝硬化患者的肝脏和肾脏均可摄取奥曲肽，后者是最重要的清除器官。奥曲肽可降低由ICG清除技术测定的肝脏代谢活性，但未证实奥曲肽对HVPG或HBF有显著影响。
