摘要
目的观察肝硬变从代偿期、失代偿期至肝肾综合征肾血流动力学的变化和肾损害的关系．方法肝硬变患者５２例，进行双肾多普勒超声检查，并检测尿中氨基葡萄糖苷酶（ＮＡＧ）活性．其中代偿期和失代偿期各２０例，肝肾综合征１２例．另选健康对照２０例，各组年龄相近．结果代偿期肾动脉内径（Ｄ）为５２ｍｍ±０４ｍｍ，肾血流量（Ｖ）为５０７ｍｌ±１４０ｍｌ，阻力指数（ＲＩ）为０６２±０１２．与对照组无差异（Ｐ＞００５）．失代偿期和肝肾综合征期Ｄ分别为３７ｍｍ±０６ｍｍ和２８ｍｍ±０２ｍｍ，Ｖ分别为１６１ｍｌ±６１ｍｌ和８９ｍｌ±１６ｍｌ，ＲＩ分别为０８４±００９和０９２±００１．比对照组和代偿期有明显变化（Ｐ＜００１）．尿ＮＡＧ在对照组是６４Ｕ±３２Ｕ，代偿期和失代偿期分别为１０３Ｕ±３６Ｕ，３８４Ｕ±２６３Ｕ（Ｐ＜００１）．以大于对照组ｘ±３ｓ为异常，血肌酐、ＢＵＮ均正常的失代偿期中６５％有早期肾损害，并ＲＩ均大于０８．而ＲＩ＞０８的患者中５９１％有早期肾损害．结论肝硬变病程中肾血流动力学变化逐渐加重．
AIM To study the relationship between renal hemodynamics and renal dysfunction from stages of compensation, decompensation to hepatorenal syndrome of liver cirrhosis. METHODS Renal duplex Doppler ultrasonography and N acetyl β glucosaminidase (NAG) concentration in urine in 52 liver cirrhosis patients were performed, among them 20 cases were in compensation stage, 20 in decompensation stage and 12 in hepatorenal syndrome stage. Another 20 healthy subjects were examined as controls. The average age in each group was about the same. RESULTS In compensation group, the internal diameter of renal artery ( D ) was 5 2mm±0 4mm, renal arterial inflow ( V ) was 507ml±140ml, and the resistance index (RI) was 0 62±0 12. These data were not significantly different from those in healthy controls ( P >0 05). In decompensation and hepatorenal syndrome groups, D was 3 7mm±0 6mm and 2 8mm±0 2mm, V 161ml±61ml and 89ml±16ml and RI 0 84±0 09 and 0 92±0 01, respectively, changes being more significant than those in control and decompensation groups ( P <0 01). Uric NAG in control group was 6 4U±3 2U,and 10 3U±3 6U and 38 4U±26 3U ( P <0 01) in compensation and decompensation groups. If ±3s of the control group was used as a cutoff value, 65% of patients in decompensation group with normal Cr and BUN had early renal injury with RI higher than 0 8. Meanwhile, by Doppler examination, 59 1% of patients with RI higher than 0 8 had early renal injury. CONCLUSION Renal hemodynamics changes become severe in the course of liver cirrhosis. There are many patients with subclinical hepatorenal syndrome in decompensation stage.
关键词
肝硬化
病理生理学
肾
肝肾综合征
血液动力学
liver cirrhosis/physiopathology
kidney/physiopathology
hepatorenal syndrome/diagnosis
hemodynamics
beta glucosidase/urine
