Gerbes A L, Gülberg V, Waggershauser T, Holl J, Reiser M
Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany.
Hepatology. 1998 Sep;28(3):683-8. doi: 10.1002/hep.510280313.
Renal effects of the transjugular intrahepatic portosystemic shunt (TIPS) were compared in 6 patients without ascites (group 1), 11 patients with ascites responding to diuretic treatment (group 2), and 6 patients with refractory ascites (group 3). Seven days after insertion of TIPS, 24-hour urinary sodium excretion had increased in patients with ascites: 113 +/- 16 mmol to 170 +/- 30 mmol (P = .012) in group 2, and 22 +/- 8 mmol to 77 +/- 27 mmol (P = .050) in group 3. In group 3, fractional sodium excretion tended to increase from 0.26% +/- 0.14% to 0.62% +/- 18% (P = .081). The relative increase of urinary sodium excretion (to 444% +/- 122%) and fractional sodium excretion (to 413% +/- 127%) in group 3 was significantly (P < .05) higher than in group 1 and group 2, respectively. Creatinine clearance and 24-hour urinary volume were not significantly changed in either group. Patients with Child-Pugh class C had a more pronounced effect of TIPS on urinary sodium excretion (increase to 396% +/- 115% vs. 139% +/- 15%; P = .066) and on fractional sodium excretion (increase to 415% +/- 103% vs. 94% +/- 15%; P = .020) than patients with less-severe liver disease. Fractional sodium excretion of less than 0.35% before TIPS was found to be an indicator of renal response to TIPS. The effect of TIPS on urinary sodium excretion and on fractional sodium excretion was related to the patients' Child-Pugh score (r = .55; P = .007 and r = .68; P = .001, respectively) and inversely to their fractional sodium excretion (r = -.44; P = .047 and r = -.54; P = .012, respectively) before TIPS. These data demonstrate that TIPS affects renal sodium handling in patients with ascites, particularly in patients with refractory ascites. Severity of liver disease and fractional sodium excretion before TIPS are parameters to predict the extent of the renal response.
对6例无腹水患者（第1组）、11例对利尿剂治疗有反应的腹水患者（第2组）和6例顽固性腹水患者（第3组）的经颈静脉肝内门体分流术（TIPS）的肾脏效应进行了比较。TIPS置入7天后，腹水患者的24小时尿钠排泄量增加：第2组从113±16 mmol增加至170±30 mmol（P = 0.012），第3组从22±8 mmol增加至77±27 mmol（P = 0.050）。在第3组中，钠排泄分数倾向于从0.26%±0.14%增加至0.62%±18%（P = 0.081）。第3组尿钠排泄量（增加至444%±122%）和钠排泄分数（增加至413%±127%）的相对增加分别显著高于第1组和第2组（P < 0.05）。两组的肌酐清除率和24小时尿量均无显著变化。Child-Pugh C级患者TIPS对尿钠排泄（增加至396%±115% vs. 139%±15%；P = 0.066）和钠排泄分数（增加至415%±103% vs. 94%±15%；P = 0.020）的影响比肝病较轻的患者更明显。发现TIPS前钠排泄分数低于0.35%是肾脏对TIPS反应的一个指标。TIPS对尿钠排泄和钠排泄分数的影响与患者的Child-Pugh评分相关（r = 0.55；P = 0.007和r = 0.68；P = 0.001），并且与TIPS前的钠排泄分数呈负相关（r = -0.44；P = 0.047和r = -0.54；P = 0.012）。这些数据表明，TIPS影响腹水患者的肾脏钠处理，特别是顽固性腹水患者。肝病严重程度和TIPS前的钠排泄分数是预测肾脏反应程度的参数。
