肝硬化患者血清一氧化氮水平与肾血流变化的观察

目的：观察肝硬化时血清一氧化氮（NO）水平与肾血流动力学变化。方法：通过硝酸还原酶法对31例常规肾功能检测正常的肝硬化患者及15例正常人血清NO测定，并对其作彩色多普勒超声主肾动脉、段间动脉、叶间动脉阻力指数（RI）测定，同时检测24h尿钠、尿肌酐。结果：肝硬化血清NO与各段肾动脉RI均显著高于对照组，肌酐清除率（Ccr）与尿钠排泄量明显低于对照组。随Child-prgh分级加重，RI渐升高，C级与A级比较差异有显著性；NO水平在C组明显高于A级与B级，Ccr和尿钠排泄量在C级明显低于B级与A级。无或少量腹水组与中大量腹水组间RI无差异，但两组RI均显著高于对照组，中大量腹水组NO显著高于无或少量腹水组及对照组。结论：肝硬化早期在腹水形成前即有肾血管阻力增加，随病变发展NO水平逐渐增加，在腹水和肝肾综合征形成中起重要作用。

Changes of serum nitric oxide and renal hemodynamics in patients with hepatic cirrhosis

Objective To observe the changes of serum nitric oxide(NO) and renal hemodynamics in patients with hepatic cirrhosis. Methods The serum NO was measured using nitric acid reductase method in 31 patients with cirrhosis, whose common renal function tests were normal, and in 15 controls. Their main, segmental and interlobar renal arterial RI were measured by Dopper ultrasonograhpy. Meanwhile the urine sodium and urine creatinine for 24 hours and serum creatinine were measured. Results The serum NO and RI were significantly higher in cirrhosis than in control. Creatinine clearance rate(Ccr) and urinary excretion of sodium were significantly lower in cirrhosis than in control. RI increased gradually with severity of liver damage, and RI was significantly higher in Child-pugh group of class C than in class A. There was significant difference in NO,Ccr and urinary excretion of sodium between Classes C and B or A. No RI difference was showed between mild or non-ascites and severe ascites patients,but NO was different in two groups. Conclusion Renal vascular resistance increases in early hepatic cirrhosis before ascites occurred. Serum NO increases gradually with the disease development. They play improtant roles in the production of ascites and hepatorenal syndrome.