肝硬化患者内皮剥脱的肝动脉和门静脉肾上腺素能反应性改变。

Altered adrenergic responsiveness of endothelium-denuded hepatic arteries and portal veins in patients with cirrhosis.

作者信息

Heller J, Schepke M, Gehnen N, Molderings G J, Müller A, Erhard J, Spengler U, Sauerbruch T

机构信息

Department of General Internal Medicine, University of Bonn, Germany.

出版信息

Gastroenterology. 1999 Feb;116(2):387-93. doi: 10.1016/s0016-5085(99)70136-8.

DOI:10.1016/s0016-5085(99)70136-8

PMID:9922320

Abstract

BACKGROUND & AIMS: Patients with cirrhosis are characterized by a reduced splanchnic vascular resistance and a hyporeactivity to adrenergic vasoconstrictors. So far, their adrenergic splanchnic vascular responsiveness has not been evaluated in vitro. We compared responses to alpha1- and beta2-adrenoceptor stimulation of hepatic arteries and portal veins of patients with cirrhosis undergoing transplantation with those of organ donors.

METHODS

Isometric contractions of endothelium-denuded vessel rings were induced cumulatively by methoxamine and relaxations by isoproterenol. Results are expressed as percentage of the contraction obtained by 85 mmol/L KCl or of the relaxation obtained by 100 micromol/L papaverine, respectively.

RESULTS

Maximal methoxamine-induced contractions were reduced in cirrhotic hepatic arteries (cirrhosis, 51.8% +/- 6.8%; donor, 89.9% +/- 6.6%; P < 0.01) and portal veins (cirrhosis, 49.2% +/- 6.4%; donor, 94.0% +/- 5.3%; P < 0.01). In cirrhosis, isoproterenol induced a less marked relaxation of hepatic arteries (cirrhosis, 46.6% +/- 3.2%; donor, 100.3% +/- 4.4%; P < 0. 01) but an increased relaxation of portal veins (cirrhosis, 41.9% +/- 6.2%; donor, 26.2% +/- 2.8%; P < 0.01).

CONCLUSIONS

In cirrhosis, endothelium-free hepatic arteries are hyporeactive to alpha1- and beta2-adrenoceptor agonists, and portal veins are hyporeactive to alpha1- but hyperreactive to beta2-adrenoceptor agonists. These findings support the in vivo findings of a hyporesponsiveness to adrenergic vasoconstrictors in patients with cirrhosis.

摘要

背景与目的

肝硬化患者的特点是内脏血管阻力降低，对肾上腺素能血管收缩剂反应低下。迄今为止，尚未在体外评估他们的肾上腺素能内脏血管反应性。我们比较了接受移植的肝硬化患者与器官供体的肝动脉和门静脉对α1-和β2-肾上腺素能受体刺激的反应。

方法

用甲氧明累积诱导去内皮血管环的等长收缩，用异丙肾上腺素诱导舒张。结果分别表示为85 mmol/L氯化钾引起的收缩或100 μmol/L罂粟碱引起的舒张的百分比。

结果

肝硬化患者肝动脉中，甲氧明诱导的最大收缩降低（肝硬化组为51.8%±6.8%；供体组为89.9%±6.6%；P<0.01），门静脉中也是如此（肝硬化组为49.2%±6.4%；供体组为94.0%±5.3%；P<0.01）。在肝硬化患者中，异丙肾上腺素引起的肝动脉舒张不太明显（肝硬化组为46.6%±3.2%；供体组为100.3%±4.4%；P<0.01），但引起的门静脉舒张增加（肝硬化组为41.9%±6.2%；供体组为26.2%±2.8%；P<0.01）。