血管紧张素转换酶抑制剂对肝硬化门静脉高压症患者门静脉血流动力学的影响

Effects of captopril on portal hemodynamics in patients with cirrhotic portal hypertension

目的观察血管紧张素转换酶抑制剂对肝硬化门静脉高压症门静脉血流动力学的影响,探讨血管紧张素转换酶抑制剂治疗肝硬化门静脉高压症的有效性及机制。方法肝硬化门静脉高压症患者80例,在服用血管紧张素转换酶抑制剂后不同时期,用彩色多普勒超声测量门静脉最大血流速度和门静脉血流量。用放射免疫法测定血浆肾素活性和醛固酮浓度。结果脾切除加断流术的肝硬化患者16例,应用血管紧张素转换酶抑制剂后30分钟、60分钟、1周时,门静脉压力分别下降0.45±0.34 kPa(P<0.05)、0.52±0.32 kPa(P<0.05)、0.43±0.24 kPa(P<0.05),门静脉血流量、最大血流速度较用药前略有增加,但无统计学意义。血浆肾素活性从4±2 mg/ml·h 升高到14±6 mg/ml·h(P<0.05),血浆醛固酮浓度从125±5ng/L 下降到45±4ng/L(P<0.05),未见明显副作用。结论血管紧张素转换酶抑制剂能快速降低门静脉压,不减少门静脉血流量,长期应用降低门静脉压力效果明显。

Objective To evaluate the effects of captopril on portal hemodynamics and explore it's efficiency and mechanism in patients with cirrhotic portal hypertension.Methods 80 patients were enrolled.After taking cap- topril,the maximal portal blood flow velocity,potal diameter,volume of portal blood flow were measured at regular time interval with colour doppler.The plasma renin activity and aldesterone concerntration were deter- mined with radioimmunoassay.The portal vein pressure was measured directly on 16 patients undergoing splenectomy and devascularization.Results At 30 min,60 min,and 1 week after administering captopril,free portal pressure dropped by 0.45±0.34 kPa(P<0.05),0.52±0.32kPa(P<0.05),0.43±0.24kPa(P <0.05)respectively.The volume of portal blood flow and maximal portal flow velocity slightly increased which is not statistically significant.Plasma renin activity rised from 4±2mg/ml·h to 14±6mg/ml·h(P<0.05) and plasma aldosterone concerntration decreased from 125±5ng/L to 45±4ng/L(P<0.05).No severe side- effect was seen.Conclusion Captopril lowers portal vein pressure without reducing volume of portal blood flow .Depressive effect is prompt,constant.