肝硬化患者肾血流及内皮素变化的临床研究

Clinical study of renal blood flow and endothelin in cirrhotic patients

目的 研究肝硬化患者肾脏血液动力学的变化。 方法 对49例肝硬化患者,采用彩色多普勒超声测定肾叶间动脉及弓形动脉搏动指数(PI)、阻力指数(RI)、收缩期最高峰值(PS)、舒张期最低峰值(PD)及收缩期最高峰值/舒张期最低峰值(PS/PD)等指数,并同时监测患者的血内皮素情况。 结果 PI和RI随肝功能损伤加重而增高,尤以RI为著。肝功能Child分级A、B、C,RI值分别为0.60±0.09、0.66±0.06、0.72±0.07,F=10.005,P<0.01;随腹水量的增加,PI、RI等亦有明显增高:少量、中—大量、顽固性腹水组PI分别为1.14±0.20、1.31±0.29、1.42±0.36,F=28.747,P<0.05。RI分别为0.61±0.09、0.68±0.07、0.77±0.05,F=17.250,P<0.01。肝硬化患者血内皮素值增高为(1.26±0.27)ng/L,且与PI及RI增高呈正相关(相关系数分别为0.556、0.576)。 结论 肝硬化患者肾血流PI和RI的变化与肝功能及腹水的加重有密切相关。内皮素可能是参与肝硬化患者肾血管收缩的重要活性因子。

Objective To find the relationship between hepatic dysfunction and renal blood flow(RBF). Method 49 patients with hepatic cirrhosis were studied via Color-Coded Duplex Ultrasonography detecting the pulsatile index(PI), resistive index(RI), peak systolic velocity(PS), peak diastolic velocity(PD) and peak systolic velocity/peak diastolic velocity(PS/PD) in the interlobar and arcuate arteries. The plasma endothelin(ET) levels were also evaluated. Result According to a modified Child's classification which assesses the severity of liver cirrhosis, we compared different groups and found that the worse the function of liver appeared coincidently with the higher PI and RI, especially RI(0.60±0.09, 0.66±0.06, 0.72±0.07, respectively, P<0.01); The results also indicated that PI, RI increased obviously followed by the rise of ascites(PI: 1.14±0.20, 1.31±0.29, 1.42±0.36, respectively; RI: 0.61±0.09, 0.68 ±0.07, 0.77±0.05, respectively). The evaluation of plasma ET level demonstrated that its increment is intimately correlated with PI and RI. Conclusion In patients with cirrhosis, RBF is directly correlated with the hepatic function. The correlation between ascites and RBF is also discovered. In patients who have liver cirrhosis, the plasma ET level obviously increased, indicating that ET probably is one of the active factors of renal vascular contraction.