Iwao T, Oho K, Nakano R, Yamawaki M, Sakai T, Sato M, Miyamoto Y, Toyonaga A, Tanikawa K
Department of Medicine II, Kurume University Hospital, 67 Asahi, Kurume 830, Japan.
Gut. 1998 Dec;43(6):843-8. doi: 10.1136/gut.43.6.843.
To investigate the relation between changes in splanchnic arterial haemodynamics and renal arterial haemodynamics in controls and patients with cirrhosis.
Superior mesenteric artery pulsatility index (SMA-PI) and renal artery pulsatility index (R-PI) were measured using Doppler ultrasonography in 24 controls and 36 patients with cirrhosis. These measurements were repeated 30 minutes after ingestion of a liquid meal or placebo. Sixteen controls and 24 patients received the meal, and eight controls and 12 patients received placebo.
In the fasting condition, patients with cirrhosis had a lower SMA-PI (p<0.01) and a greater R-PI (p<0.01) compared with controls. Placebo ingestion had no effect on splanchnic and renal haemodynamics. In contrast, ingestion of the meal caused a notable reduction in SMA-PI (p<0.01, p<0.01) and an increase in R-PI (p<0.01, p<0.01) in controls and patients with cirrhosis. The meal induced haemodynamic change in SMA-PI was inversely correlated with that in R-PI in controls (t=-0.42, p<0.05) and in patients with cirrhosis (t=-0.29, p<0.05).
Results support the hypothesis that renal arterial vasoconstriction seen in patients with cirrhosis is one of the kidney's homoeostatic responses to underfilling of the splanchnic arterial circulation.
研究健康对照者和肝硬化患者内脏动脉血流动力学变化与肾动脉血流动力学变化之间的关系。
采用多普勒超声测量24名健康对照者和36名肝硬化患者的肠系膜上动脉搏动指数（SMA-PI）和肾动脉搏动指数（R-PI）。在摄入流食或安慰剂30分钟后重复测量。16名对照者和24名患者摄入食物，8名对照者和12名患者摄入安慰剂。
在空腹状态下，肝硬化患者的SMA-PI低于对照者（p<0.01），R-PI高于对照者（p<0.01）。摄入安慰剂对内脏和肾脏血流动力学无影响。相反，摄入食物导致对照者和肝硬化患者的SMA-PI显著降低（p<0.01，p<0.01），R-PI升高（p<0.01，p<0.01）。在对照者（t=-0.42，p<0.05）和肝硬化患者（t=-0.29，p<0.05）中，食物引起的SMA-PI血流动力学变化与R-PI的变化呈负相关。
结果支持以下假设，即肝硬化患者出现的肾动脉血管收缩是肾脏对内脏动脉循环血容量不足的一种稳态反应。
