肝硬化患者血钠水平与肾功能损害的关系

目的研究肝硬化腹水患者血钠水平与肾功能损害的关系。方法将115例肝硬化腹水患者分为低血钠组（58例）与正常血钠组（57例）两组,对两组进行血浆肾毒活性（PRA）、血管紧张素Ⅱ（AⅡ）、醛固酮（ALD）及肾功能损害的对比研究。结果低血钠组PRA（3.02±0.51）ng.ml-1.小时-1、AⅡ（232.38±47.17）pg/ml、ALD（751.98±87.23）pg/ml,显著高于正常血钠组：PRA（1.41±0.22）ng.ml-1.小时-1、AⅡ（117.77±27.25）pg/ml、ALD（290.26±29.52）pg/ml,t=15.92~37.88,P〈0.01,低血钠组58例中有肾功能损害（尿素氮、肌酐升高）10例（17.24%）,正常血钠组57例中肾功能损害0例,x2=10.77,P〈0.01。结论肝硬化腹水患者发生低血钠时,使PRA、AⅡ、ALD升高,易诱发肾功能损害。     

血浆、腹水中心钠素、加压素的测定及意义

本文采用放射免疫分析法测定25例肝硬化腹水患者血浆、腹水中心钠素和加压素的水平，发现血浆，腹水中心钠素水平相当，均明显高于正常血浆水平；血浆加压素升高不明显，而腹水中加压素浓度显著高于血浆。结果提示心钠素和加压素的分泌释放异常，在肝硬化钠，水潴留及腹水形成中有一定的作用。腹水中高浓度的心钠素和加压素通过腹水回输可能起到一定的治疗作用。     

超早期缺血性脑血管病血浆NO、ET变化及意义

分别应用硝酸酶还原法和放免分析法测定发病6 h内的脑梗死患者(CI组)和短暂性脑缺血发作患者(TIA组)的血浆NO、内皮素(ET)水平,并与正常对照组进行比较.结果TIA组血浆NO水平明显低于对照组,ET水平高于对照组;CI组血浆NO、ET水平明显高于对照组和TIA组(P均＜0.01).直线相关分析显示,梗死灶体积与血浆NO、 ET呈正相关.认为超早期缺血性脑血管病患者血浆NO、ET水平可作为脑缺血损害程度的指标.     

不限钠饮食与限钠饮食对肝硬化患者白蛋白、肾血流量及腹水消退的影响

近年来，对肝硬化腹水患者是否要严格限钠已有争论，本研究将80例肝硬化腹水患者随机分为不限钠饮食与限钠饮食两组，对两组患者的血钠、尿钠、血浆肾素活性（PRA）、血管紧张素Ⅱ（AⅡ）、醛固酮（ALD）、血清白蛋白、肾血流量、肾功能损害、利尿效果、腹水消退情况作对比研究。     

肝硬化患者血浆一氧化氮和内毒素水平及相互关系

本试验测定了４０例肝硬化患者和１０例正常人的血浆内毒素和一氧化氮含量。结果示：无复水组血浆ＮＯ和内毒素高于正常人,有腹水组高于无腹水组,肾功能损害组高于无肾功损害组。血浆内毒素和ＮＯ含量呈正相关,提示二者与肝硬化及腹水形成有一定关系,与肾功损害有关。     

补钠与限钠对肝硬化血肾素、血管紧张素Ⅱ、醛固酮及肾功能的影响

将67例肝硬化腹水患者随机分为补钠与限钠治疗两组，对血钠、氯、血浆肾素活性(PRA)、血管紧张素Ⅱ(AⅡ)、醛固酮(ALD)、肾功能损害、利尿效果及腹水消退作对比研究。     

利尿和补钠治疗失代偿期肝硬化

目的探讨在应用利尿剂的同时补钠治疗失代偿期肝硬化。方法97例失代偿期肝硬化患者随机分为补钠组48例和限钠组49例,测定血钠、氯、尿钠、氯、血浆肾素活性(PRA)、血管紧张素Ⅱ(AⅡ)、醛固酮(ALD),并比较肝性脑病发生及腹水消退等情况。结果治疗后补钠组患者血钠、氯水平提高,尿钠排除增多,血PRA、AⅡ和ALD水平降低,肝性脑病和肾功能损害发生率低,疗效明显优于限钠组。结论在应用利尿剂的同时适当补钠治疗失代偿期肝硬化患者,有利于减少肝性脑病和肾功能损害的发生,而且能增加利尿效果,消退腹水,改善预后。     

血浆内源性阿片肽升高与肝硬化外周动脉扩张及腹水形成的关系

目的：探讨血浆三种内源性阿片肽浓度变化，以了解它与肝硬化外周动脉扩张及腹水形成的关系。方法：用放免法检测了20例正常人，20例非肝病及50例肝硬化患者的血浆强啡肽（DynA1－13），亮啡肽（L－ENK）和β-内啡肽（β-EP）。结果：肝硬化无腹水组和有腹水组血浆DynA1－13和L-ENK浓度均明显高于正常对照组和非肝病对照组（P均＜0．01）；随病情加重，DynA1－13和L－ENK均呈上升趋势，肝硬化有腹水组的L－ENK亦明显高于无腹水组（P＜0．01）。相关分析表明：DynA1－13与A／G比值、L－ENK与A／G比值之间均呈显著负相关；血浆DynA1－13与L－ENK之间呈显著正相关。二组肝硬化患者血浆β－EP浓度与正常组和非肝病对照组比较，差异无显著性。结论：DynA1－13和L-ENK反映肝硬化的严重程度，并且在肝硬化外周动脉扩张及钠水潴因导致腹水形成中起重要作用β-EP不起主要作用。     

肝硬化患者血浆内皮素浓度观察

用放射免疫分析法测定２２例肝硬化及１３例正常人血浆内皮素（Ｅｎｄｏｔｈｅｌｉｎ，ＥＴ）含量，２２例肝硬化患者血浆ＥＴ明显高于正常人（各为９８．４±１３．１ｐｇ／ｍｌ和４６．５±８．２ｐｇ／ｍｌ，Ｐ＜０．０１）；无腹水组血浆ＥＴ为１３９．０±２０．６ｐｇ／ｍｌ，高于腹水组（Ｐ＜０．０１）；腹水组无功能性肾衰时腹水组无功能性肾衰者血浆ＥＴ浓度，与伴有功能性肾衰组相比，两者无显著差别（Ｐ＞０．０５）。无显著差别（Ｐ＞０．０５）。提示血浆ＥＴ参与血管紧张度的维持，可能与肝硬化时腹水形成及功能性肾衰有一定关系。     

不限钠饮食与限钠饮食对肝硬化患者肾血流量及腹水消退的影响

近年来,对肝硬化腹水患者是否要严格限钠已有争论,本文研究将70例肝硬化腹水患者分为不限钠饮食与限钠饮食两组,并对两组患者血钠、尿钠、血浆肾素活性(PRA)、血管紧张素Ⅱ(A Ⅱ)、醛固酮(ALD)、肾血流量、利尿效果、腹水消退及肾功能损害等情况作对比分析,现报道如下.     

Plasma endothelin levels in patients with cirrhosis and their relationships to the severity of cirrhosis and renal function

Background/Aims: Increased plasma endothelin levels have been reported in patients with cirrhosis. However, the relationship between plasma endothelin concentrations and hyperdynamic circulation or renal functions has not been documented.Methods: We measured the plasma endothelin-1 and endothelin-3 concentrations using radioimmunoassay in 96 patients with cirrhosis (Pugh's A in 26, Pugh's B in 45 and Pugh's C in 25) and compared these values to 56 age- and sex-matched healthy subjects. Systemic and portal hemodynamic measurements, effective renal plasma flow, creatinine clearance, plasma aldosterone concentration and plasma renin activity were recorded for each patient.Results: Plasma endothelin-1 and endothelin-3 levels were significantly increased in patients with cirrhosis compared to healthy subjects. Additionally, plasma endothelin-1 and endothelin-3 values were higher in patients with cirrhosis and ascites than in those without ascites. Moreover, plasma endothelin-1 levels increased in relation to the severity of cirrhosis. On the other hand, modest negative correlations were found betwen endothelin-1 and creatinine clearance or effective renal plasma flow.Conclusions: Plasma endothelin-1 and endothelin-3 levels are increased in patients with cirrhosis compared to healthy subjects. The increase in plasma endothelin-1 levels is related at least in part to the severity of cirrhosis. Increased endothelin-1 levels may possibly contribute to renal dysfunction in patients with cirrhosis.     

Plasma erythropoietin level in patients with cirrhosis and its relationship to the severity of cirrhosis and renal function

BACKGROUND AND AIM: The level of plasma erythropoietin (EPO) in patients with cirrhosis is controversial. It is known that overproduction of nitric oxide (NO) plays, in part, a role for the development of peripheral arterial vasodilatation in cirrhosis with portal hypertension. It has also been hypothesized that a possible interaction is noted between endogenous EPO and NO production. The current study was undertaken to evaluate the relationship between plasma EPO levels and the severity of liver disease, hemodynamic values, renal functions, and plasma nitrate/nitrite levels in patients with cirrhosis. METHODS: The authors measured the biochemistry, plasma EPO and nitrate/nitrite levels in 67 patients with cirrhosis (Child-Pugh class A in 23 and Child-Pugh class B and C in 44) and compared their values with those in 34 healthy subjects. Systemic and splanchnic hemodynamic measurements and effective renal plasma flow were obtained from cirrhotic patients. RESULTS: Plasma EPO and nitrate/nitrite levels were significantly increased in patients with cirrhosis compared with healthy subjects. Additionally, plasma EPO values were higher in cirrhotic patients with ascites or with anemia than in those without ascites or without anemia, respectively. Plasma EPO levels were positively correlated to the hepatic venous pressure gradient (HVPG) and Child-Pugh score, negatively correlated to the renal and hepatic blood flows, but were not correlated to nitrate/nitrite level and systemic vascular resistance in cirrhotic patients. Multiple regression analysis showed that HVPG and renal plasma flow were independent predictors for the elevated EPO level in cirrhotic patients. CONCLUSIONS: Plasma EPO levels were increased in patients with cirrhosis compared with those in healthy subjects. The increase in plasma EPO levels is related to the degree of portal hypertension, the severity of cirrhosis and the renal plasma flow. In contrast, the EPO levels had no correlation to the nitrate/nitrite levels and systemic vascular resistance in patients with cirrhosis.     

Hyperglucagonaemia in cirrhotic patients and its relationship to the severity of cirrhosis and haemodynamic values

Plasma glucagon concentrations were measured in 160 cirrhotic patients (Pugh's grade A in 52 patients, Pugh's grade B in 64 patients and Pugh's grade C in 44 patients). These values were compared with plasma glucagon concentrations in 57 age and sex-matched healthy subjects. Systemic and portal haemodynamic measurements, effective renal plasma flow and creatinine clearance were recorded for each patient. Plasma glucagon levels were significantly increased in cirrhotic patients compared with healthy subjects. In addition, plasma glucagon levels were higher in cirrhotic patients with ascites than in those without ascites and were increased in relation to the severity of cirrhosis as assessed by Pugh's score. Multiple linear regression found that only Child-Pugh's score was estimated to be an independent predictor of hyperglucagonaemia in cirrhotic patients. However, in patients with different degrees of oesophageal varices and in patients without oesophageal varices, plasma glucagon concentrations were no different among the different groups of patients, but were still higher than plasma glucagon concentrations in healthy subjects. In contrast, plasma glucagon levels were negatively correlated with mean arterial pressure and systemic vascular resistance. The results of the present study suggest that impairment of liver function plays, in part, a role in increased plasma glucagon levels observed in patients with cirrhosis. In addition, these data support the hypothesis that hyperglucagonaemia may contribute, at least in part, to the pathogenesis of peripheral arterial vasodilatation in cirrhosis with portal hypertension.     

肝硬化患者的内毒素和脂多糖结合蛋白水平及其与预后的关系

背景脂多糖结合蛋白(LBP)是介导脂多糖(LPS)活化单核/巨噬细胞的关键因子。尽管内毒素在慢性肝病和肝硬化中具有重要作用,但其结合蛋白在肝硬化中的意义尚不清楚。目的了解肝硬化患者的内毒素和LBP水平,并探讨其与预后的关系。方法分别以基质显色法鲎试验和酶联免疫吸附测定(ELISA)检测肝硬化患者的血浆内毒素和LBP水平;伴腹水患者同时测定腹水内毒素和LBP水平,并进行2个月的短期随访,记录存活情况。结果肝硬化患者的血浆内毒素和LBP水平均显著高于健康对照者(P<0.05),其中伴腹水患者的血浆内毒素水平显著高于无腹水患者(P<0.05)。Child鄄PughC级肝硬化伴腹水患者的腹水内毒素水平显著高于B级患者(P<0.05),而B级患者的血浆LBP水平显著高于C级患者(P<0.05)。短期随访显示肝硬化伴腹水死亡患者的腹水内毒素水平显著高于存活者(P<0.05)。结论肝硬化患者的血浆内毒素和LBP水平均升高,LBP水平升高可能是对肝硬化肠源性内毒素血症的一种持续的慢性炎症应答。腹水内毒素水平可以作为肝硬化伴腹水患者短期生存的一个预测指标。     

Plasma levels of brain natriuretic peptide in patients with cirrhosis.

Plasma levels of brain natriuretic peptide, a recently identified cardiac hormone with natriuretic activity, were measured in 11 healthy subjects, 13 cirrhotic patients without ascites, 18 nonazotemic cirrhotic patients with ascites and 6 patients with cirrhosis, ascites and functional kidney failure. Plasma levels of brain natriuretic peptide were similar in healthy subjects and cirrhotic patients without ascites (5.56 +/- 0.65 and 7.66 +/- 0.68 fmol/ml, respectively). In contrast, cirrhotic patients with ascites, with and without functional kidney failure, had significantly higher plasma concentrations of brain natriuretic peptide (19.56 +/- 1.37 and 16.00 +/- 1.91 fmol/ml, respectively) than did healthy subjects and patients without ascites (p less than 0.01); no significant difference was found between the two groups of cirrhotic patients with ascites with respect to this parameter. In the whole group of cirrhotic patients included in the study, brain natriuretic peptide level was directly correlated with the degree of impairment of liver and kidney function, plasma renin activity and plasma levels of aldosterone and atrial natriuretic peptide. The results of this study indicate that brain natriuretic peptide is increased in cirrhotic patients with ascites and suggest that sodium retention in cirrhosis is not due to deficiency of this novel cardiac hormone.     

Dendroaspis natriuretic peptide in hepatic cirrhosis

OBJECTIVES: Dendroaspis natriuretic peptide (DNP) is a novel peptide that is structurally similar to atrial, brain, and C-type natriuretic peptides. Many natriuretic peptides are increased in hepatic cirrhosis, but the role of DNP in cirrhosis is unknown at present. The aim of the study was to investigate plasma levels of dendroaspis natriuretic-like immunoreactivity in cirrhosis. METHODS: We measured plasma concentrations of DNP by radioimmunoassay methods in 12 cirrhotic patients without ascites and 44 cirrhotic patients with ascites, and compared these values with 20 age-matched healthy subjects. Renal function, plasma cGMP concentration, plasma renin activity, and plasma endothelin concentration were measured in each patient. RESULTS: Patients without ascites had circulating levels of DNP similar to those of healthy subjects. By contrast, patients with ascites had increased circulating DNP levels compared to both patients without ascites and healthy subjects. In addition, circulating levels of DNP increased in relation to the severity of cirrhosis. Significant positive correlations were also found between DNP levels, endothelin concentrations, and plasma renin activity. CONCLUSIONS: The results of this study indicate that plasma DNP is increased in cirrhotic patients with ascites.     

Effects of somatostatin on renal function in cirrhosis.

To investigate the renal effects of somatostatin in cirrhosis, renal function and plasma and urinary levels of endogenous neurohumoral vasoactive substances were measured in conditions of intravenous water overload (20 mL/kg body wt with 5% glucose) before and during the intravenous infusion of somatostatin (250-500 micrograms/h) in 6 cirrhotic patients without ascites and 17 nonazotemic cirrhotic patients with ascites. Somatostatin induced a significant reduction of renal plasma flow, glomerular filtration rate, and free water clearance in both groups of patients. In patients with ascites, somatostatin also reduced urinary sodium excretion. Changes in renal function were significantly more marked in patients with ascites than in those without ascites and occurred in the absence of changes in mean arterial pressure and plasma levels of renin, aldosterone, norepinephrine, antidiuretic hormone, and atrial natriuretic peptide. Somatostatin induced a significant reduction in the plasma concentration of glucagon and urinary excretion of prostaglandin E2 that was not related to changes in renal function. These findings indicate that somatostatin administration induces renal vasoconstriction and impairs glomerular filtration rate, free water clearance, and sodium excretion in cirrhosis by a mechanism unrelated to systemic hemodynamics and endogenous neurohumoral vasoactive systems.     

肝硬化患者血浆洋地黄样免疫反应物质水平的临床研究

目的 洋地黄样免疫反应物质(DLIS)是参与机体水钠代谢调控的体液因子之一。本文研究肝硬化患者血浆DLIS水平的改变及规律性,并探讨其发生机理。 方法 以地高辛抗体经放射免疫法(RIA)检测80例肝硬化患者的血浆DLIS水平,对照组为50名正常人。 结果 肝硬化组血浆DLIS水平显著高于对照组,其中腹水组又显著高于无腹水组,大量腹水组则显著高于中少量腹水组,Child A,B,C各组间亦存在显著性差异。肝硬化组血浆DLIS水平与肝肾功能障碍及水钠代谢失衡的实验室指标呈显著相关性。 结论 研究结果表明,血浆DLIS水平的改变与肝硬化的病理生理过程有密切关系,即肝硬化时的机体水钠超负荷状态及肝肾功能障碍可能导致DLIS的分泌、代谢及清除的异常或失调。     

Evaluation of Gallbladder Motility in Patients with Liver Cirrhosis

To investigate the postprandial gallbladder motility, including emptying and refilling, in cirrhotic patients and to evaluate the relationship to the presence of gallstones and various humoral mediators, 82 patients with liver cirrhosis and 40 age- and sex-matched healthy subjects were enrolled into this study. Postprandial gallbladder volumes were measured with ultrasonography every 15 min for 2 hr. Plasma levels of estradiol, testosterone, substance P, and nitrate/nitrite were also measured. Cirrhotic patients showed a higher prevalence of gallstones than healthy subjects (41% vs 15%, P = 0.003), and the prevalence increased with the progression of liver cirrhosis (Child-Pugh class A: 26%, B: 44%, and C: 65%, P = 0.02). Plasma levels of estradiol, testosterone, and substance P, and nitrate/nitrite and estradiol/testosterone ratios were not different between cirrhotic patients with and without gallstones. However, postprandial refilling of the gallbladders was significantly impaired in patients with cirrhosis, especially in those combined with gallstones. There was no significant difference in the postprandial gallbladder motility between cirrhotic patients with and without elevated plasma levels of estradiol, testosterone, and substance P and nitrate/nitrite, and estradiol/testosterone ratios. Gallstones were common in patients with liver cirrhosis and the prevalence increased with the progression of liver diseases. Sex hormones, substance P, and nitrate/nitrite did not play major roles in the formation of gallstones in cirrhotic patients. Refilling of the gallbladder was significantly impaired in patients with liver cirrhosis, especially in those with gallstones, and may play an important role in the pathogenesis of gallstones.     

One-week losartan administration increases sodium excretion in cirrhotic patients with and without ascites

Background. Losartan, a highly selective angiotensin II type 1 receptor antagonist, has been reported to have a significant portal hypotensive effect in cirrhotic patients. A recent study also showed that losartan exerted a dramatic natriuretic effect in preascitic cirrhosis. The influence of losartan on renal hemodynamics and sodium homeostasis in cirrhotic patients with ascites is unclear. This study was undertaken to evaluate the renal effects of 1-week losartan treatment in cirrhotic patients with and without ascites. Methods. All 12 patients in the study received a daily oral dose of 25 mg losartan for 7 consecutive days. Effective renal plasma flow, urine volume, creatinine clearance, 24h urine sodium excretion and fractional excretion of sodium, blood urea nitrogen, and serum creatinine were measured before and after treatment. Results. In cirrhotic patients without ascites, creatinine clearance, 24-h urinary sodium excretion, and fractional excretion of sodium were significantly increased after losartan administration. Effective renal plasma flow and serum creatinine showed almost no change after treatment. In cirrhotic patients with ascites, creatinine clearance, 24-h urinary sodium excretion, fractional excretion of sodium, and effective renal plasma flow were significantly increased after losartan administration. In addition, the magnitudes of the increases in the fractional excretion of sodium and in the 24-h urinary sodium excretion were greater in cirrhotic patients with ascites than in those without ascites. Conclusions. One-week treatment with losartan increases sodium excretion in association with an improvement of renal function in cirrhotic patients with and without ascites. The natriuretic effect was more profound in cirrhotic patients with ascites than in those without ascites. Received: May 1, 2001 / Accepted: August 24, 2001