Relationship between activation of the sympathetic nervous system and renal blood flow autoregulation in cirrhosis
Relationship between activation of the sympathetic nervous system and renal blood flow autoregulation in cirrhosis
复制标题
DOI：
10.1053/j.gastro.2007.10.055
复制
发表时间：
2008-01-01
期刊：
影响因子：
29.4
通讯作者：
Jalan, Rajiv
中科院分区：
文献类型：
--
作者：
Stadlbauer, Vanessa P.;Wright, Gavin A. K.;Jalan, Rajiv
背景与目的：交感神经系统的激活导致肾自动调节曲线右移，导致肾血流量严重依赖于肾灌注压，从而导致肝肾综合征的发生。本研究旨在探讨经颈静脉肝内门体分流术(TIPS)后，肝硬变患者肾血流量与肾灌注压的关系及对肾血流动力学的影响。方法：56例患者分为无腹水组、利尿剂敏感腹水组、顽固性腹水组、II型肝肾综合征组和顽固性腹水组。我们测量了心脏血流动力学、肾脏血流量、肾脏灌注压、门脉压力和去甲肾上腺素水平，并对肾脏自动调节曲线进行了数学建模。结果：肾血流量与肾灌注压呈正相关(r(2)=0.78；P
Background & Aims: It has been proposed that activation of the sympathetic nervous system causes a rightward shift in the renal autoregulatory curve such that renal blood flow is critically dependent on renal perfusion pressure and that this contributes to the development of the hepatorenal syndrome. The aims of the study were to determine the relationship of renal blood flow and renal perfusion pressure in patients with liver cirrhosis and the effect on renal hemodynamics following insertion of a transjugular intrahepatic portosystemic shunt (TIPS). Methods: Fifty-six patients were recruited into groups (1) with no ascites, (2) with diuretic-responsive ascites, (3) with intractable ascites, (4) with type II hepatorenal syndrome, and (5) requiring a TIPSs for refractory ascites. We measured cardiac hemodynamics, renal blood flow, renal perfusion pressure, and portal pressure and norepinephrine levels and mathematically modeled the renal autoregulatory curve. Results: Renal blood flow correlated with renal perfusion pressure (r(2) = 0.78; P