限钠与不限钠对肝硬化患者肾素、肾血流量及腹水的影响

Influence of non-sodium restricted diet with diuretics on plasma rennin, renal blood flow and in patients with cirrhotic ascites

目的探讨不限钠饮食与限钠饮食对肝硬化腹水患者血浆肾素（PRA）、血管紧张素Ⅱ（AII）、醛固酮（ALD）、肾血流量（RBF）和腹水消退的影响。方法80例乙型肝炎肝硬化腹水患者随机分为不限钠饮食和限钠饮食两组，不限钠饮食组39例，每日氯化钠6500～8000mg，限钠饮食组41例，每日氯化钠5000mg，两组患者均用呋塞米、螺内酯利尿，比较治疗后血钠、尿钠、PRA、AII、ALD、RBF和腹水消退的情况。结果不限钠饮食组治疗10d后血钠、尿钠、尿量较治疗前增多，也较限钠饮食组治疗10d后增多，PRA、AII、ALD较治疗前降低，也较限钠饮食组治疗后10d降低，P〈0．01，肾血流景较治疗前增多，也较限钠饮食组治疗后10d增多，P〈0．01，治疗后低血钠诱发肾功能损害，不限钠饮食组少于限钠饮食组，P〈0．05，至出院时腹水消失，不限钠饮食组多于限钠饮食组，P〈0．01，腹水消失时间，不限钠饮食组短于限钠饮食组，P〈0．01。结论与限钠饮食比较，在使用利尿剂同时，不限钠饮食能增加血钠水平，因而增加尿钠排泄，能增加利尿效果，并能降低PRA、All、ALD水平，增加肾血流量，防止低血钠诱发肾功能损害，因而有利于腹水消退。

Objective To explore influence of sodium restricted diet and non-sodium restricted diet on plasma rennin （PRA） , angiotensin II （AII） , ALD, renal blood flow （RBF） and subside of ascites in patients with cirrhotic ascites. Methods Eighty cases of hepatitis B with cirrhotic ascites were randomly divided into sodium restricted diet group and non-sodium restricted diet group. 39 cases were in non-sodium restricted diet group, taking sodium chloride 6500-8000 mg daily; 41 cases were in sodium restricted diet group, taking sodium chloride 5000 mg daily. Both groups received diuretics furosemide and spironolactone. Blood sodium, urine sodium, PRA, AII, ALD, RBF ascites subsiding were compared after treatment. Results In non-sodium restricted diet group, blood sodium and urine sodium increased 10 days after treatment compared with those before treatment, and compared with those of sodium restricted diet group 10 days after treatment, P 〈 0.01. RBF increased compared with that before treatment, and compared with that of sodium restricted diet group 10 days after treatment, P 〈 0. 01. Renal damage induced by low blood sodium after treatment was less in non-sodium restricted diet group than that in sodium restricted diet group, P 〈 0. 05. Ascites disappearance upon discharge was more in sodium restricted diet group than that in non- sodium restricted diet group, P 〈 0.01. Time of ascites disappearance was shorter in non-sodium restricted diet group than that in sodium restricted diet group, P 〈 0. 01. Conclusion Compared with sodium restricted diet, while using diuretics of both groups, non-sodium restricted diet can increase level of blood sodium, thus increasing excretion of urine sodium and diuretic effect. It can also decrease levels of PRA, AII and ALD, increase renal blood flow and prevent renal damage induced by low blood sodium and facilitate subsiding of ascites.