Renal vasoconstriction in cirrhosis evaluated by duplex doppler ultrasonography
Renal vasoconstriction in cirrhosis evaluated by duplex doppler ultrasonography
复制标题
双功多普勒超声评估肝硬化肾血管收缩
作者：
D. Sacerdoti;M. Bolognesi;C. Merkel;P. Angeli;A. Gatta
当肾功能测试仍然正常时对肾灌注的研究可能有助于了解肝硬化中功能性肾损伤的病理生理学；目前，这需要侵入性方法。双重多普勒超声检查可以对肾内动脉阻力进行无创评估。在 19 名肾功能正常（血清肌酐和尿素水平正常）的非腹水性肝硬化患者和 35 名腹水性肝硬化患者以及 17 名对照患者中，我们测量了肾内动脉搏动指数（搏动指数 = [峰值收缩速度 – 最小舒张速度]/平均速度）和阻力指数（阻力指数 = [峰值收缩速度 – 最小舒张速度]）通过彩色多普勒超声检查观察叶间、小叶间或弓形动脉后，通过双功多普勒超声检查来计算“速度]/峰值收缩速度）。肝硬化患者的搏动指数和阻力指数（计算为连续三到五次测定的平均值）显着高于对照患者（搏动指数：1.16 ± 0.24 与 0.78 ± 0.05 [平均值 ± S.D.]，p < 0.001；阻力指数：0.67 ± 0.06 与 0.53 ± 0.03，p < 0.001)。非腹水性肝硬化患者的搏动指数和阻力指数显着高于对照患者，腹水患者显着高于非腹水患者，未接受利尿剂治疗的腹水患者显着高于非腹水患者，接受利尿剂治疗的腹水患者显着高于未治疗的腹水患者。 7 名患者在利尿剂治疗前后（7 至 15 天）测量的搏动指数和阻力指数因治疗而显着增加。 Child-Turcotte-Pugh B 级和 C 级患者的搏动指数和阻力指数显着高于 A 级患者。搏动指数和阻力指数与肌酐清除率呈负相关，与心率呈正相关。因此，通过多普勒超声检查评估的肾动脉阻力指数在肝硬化非腹水期已经增加，并且在腹水期更大，特别是在利尿治疗期间，这也被证明会增加肾阻力。这种无创方法可应用于肝硬化肾功能损害的病理生理学和临床研究。 （肝病学 1993；17：219–224。）
Studies of renal perfusion when kidney function tests are still normal could be useful to understand the pathophysiology of functional kidney impairment in cirrhosis; currently, this requires invasive methodology. Duplex Doppler ultrasonography allows noninvasive evaluation of intrarenal arterial resistances. In 19 nonascitic and 35 ascitic cirrhotic patients with normal kidney function (normal serum creatinine and urea levels) and in 17 controls, we measured the intrarenal arterial pulsatility index (Pulsatility index = [Peak systolic velocity – Minimum diastolic velocity]/Mean velocity) and the resistive index (Resistive index = [Peak systolic velocity – Minimum diastolic velocity]/Peak systolic velocity) by duplex Doppler ultrasonography after visualization of interlobar, interlobular or arcuate arteries by color Doppler ultrasonography. The pulsatility index and resistive index (calculated as the mean of three to five consecutive determinations) were significantly higher in cirrhotic patients than in control patients (pulsatility index: 1.16 ± 0.24 vs. 0.78 ± 0.05 [mean ± S.D.], p < 0.001; resistive index: 0.67 ± 0.06 vs. 0.53 ± 0.03, p < 0.001). The pulsatility index and resistive index were significantly higher in nonascitic cirrhotic patients than in control patients, in ascitic patients than in nonascitic patients, in ascitic patients not treated with diuretics than in nonascitic ones and in ascitic patients treated with diuretics than in those not treated. The pulsatility index and resistive index measured before and after treatment with diuretics (7 to 15 days) in seven patients were significantly increased by treatment. The pulsatility index and resistive index were significantly higher in Child‐Turcotte‐Pugh class B and C patients than in class A patients. The pulsatility index and resistive index inversely correlated with creatinine clearance and directly correlated with heart rate. Thus renal arterial resistance indexes evaluated by duplex Doppler ultrasonography were already increased in the nonascitic phase of cirrhosis and were greater in the ascitic phase, particularly during diuretic treatment, which was also shown to increase renal resistance. This noninvasive method may be applied to pathophysiological and clinical studies of the renal functional impairment of cirrhosis. (HEPATOLOGY 1993;17:219–224.)