肝硬化患者常有以潴钠和排水异常为特征的肾功能不全,其发病机理至今尚未完全阐明。近年肾脏血液动力学和钠调节激素测定的研究取得了较大的进展。一、肾脏因素 1.有效血容量减少:既往认为肝硬化患者的肝窦状隙和内脏毛细血管Starling力临界失衡时,有大量淋巴液形成。当超过淋巴管及胸导管的输送能力,过多的淋巴液积聚在腹腔而产生腹水,引起血容量再分布,有效血容量减少。后者可能通过压力感受器讯号输入使肾小管对钠和水的重吸收增加,导致钠、水的排泄减少。近年来,Epstein等对肝硬化患者进行水沉浸试验,结果发现水沉浸后钠排泄显著增加。因此,有效血容量减少是肝硬化患者潴钠和排水异常的一大因素。 2.肾内血流量重分配与肾血管收缩:kew等,对33例肝硬化患者应用~(133)氙洗涤法直接测定肾内血流 Patients with liver cirrhosis are often characterized by retention of sodium and abnormal drainage of renal insufficiency, the pathogenesis has not been fully elucidated. In recent years, renal hemodynamics and sodium-regulated hormones have made great progress. First, the renal factors 1. Effective hypovolemia: Historically, patients with cirrhosis of the hepatic sinusoid and visceral capillary Starling force critical imbalance, the formation of a large number of lymph. When more than lymphatic vessels and thoracic duct delivery capacity, excessive accumulation of lymph in the abdominal cavity and ascites, causing redistribution of blood volume, effective hypovolemia. The latter may increase renal tubular reabsorption of sodium and water through baroreceptor signaling, resulting in decreased sodium and water excretion. In recent years, Epstein and other patients with cirrhosis of water immersion test showed that sodium excretion increased significantly after water immersion. Therefore, the effective blood volume reduction is cirrhosis of patients with abnormal retention of sodium and a major factor. Renal blood flow redistribution and renal vasoconstriction: kew, 33 cases of patients with cirrhosis using ~ (133) Xenon washing method directly measured renal blood flow