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首页> 外文期刊>American Journal of Physiology >Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis
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Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis

机译：Transjugular肝内portoSystemic分流器：对肝硬化患者的系统血流动力学和肾和心脏功能的影响

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Transjugular intrahepatic portosystemic shunt (TIPS) alleviates portal hypertension and possibly increases central blood volume (CBV). Moreover, renal function often improves; however, its effects on cardiac function are unclear. The aims of our study were to examine the effects of TIPS on hemodynamics and renal and cardiac function in patients with cirrhosis. In 25 cirrhotic patients, we analyzed systemic, cardiac, and splanchnic hemodynamics by catheterization of the liver veins and right heart chambers before and 1 wk after TIPS. Additionally, we measured renal and cardiac markers and performed advanced echocardiography before, 1 wk after, and 4 mo after TIPS. CBV increased significantly after TIPS (+4.6%, P < 0.05). Cardiac output (CO) increased (+15.3%, P < 0.005) due to an increase in stroke volume (SV) (+11.1%, P < 0.005), whereas heart rate (HR) was initially unchanged. Cardiopulmonary pressures increased after TIPS, whereas copeptin, a marker of vasopressin, decreased (- 18%, P < 0.005) and proatrial natriuretic peptide increased (+52%, P < 0.0005) 1 wk after TIPS and returned to baseline 4 mo after TIPS. Plasma neutrophil gelatinase-associated lipocalin, renin, aldosterone, and serum creatinine decreased after TIPS (-36%, P < 0.005; -65%, P < 0.05; -90%, P < 0.005; and -13%, P < 0.005, respectively). Echocardiography revealed subtle changes in cardiac function after TIPS, although these were within the normal range. TIPS increases CBV by increasing CO and SV, whereas HR is initially unaltered. These results indicate an inability to increase the heart rate in response to a hemodynamic challenge that only partially increases CBV after TIPS. These changes, however, are sufficient for improving renal function.
机译：Transjugular肝内portoSystemic分流器（提示）缓解门静脉高压，可能增加中央血容量（CBV）。此外，肾功能通常会改善;然而，它对心脏功能的影响尚不清楚。我们研究的目的是研究提示对肝硬化患者血流动力学和肾功能和心功能的影响。在25例肝硬化患者中，我们通过肝脏静脉和右心室的导管分析了系统性，心脏和Splanchnic血流动力学，并在提示后1周。另外，我们测量肾病和心脏标志物，并在尖端以后进行先进的超声心动图，1wk和4℃。提示后CBV显着增加（+ 4.6％，P <0.05）。由于中风体积（+ 11.1％，P <0.005）的增加，心脏输出（CO）增加（+ 15.3％，P <0.005），而心率（HR）最初不变。尖端后心肺压力增加，而Copeptin，含有血管加压素的标志物，降低（ - 18％，P <0.005）和初步后的初步尿肽（+ 52％，P <0.0005）1周，并在提示后返回基线4 Mo 。血浆中性粒细胞明胶酶相关的脂素，肾素，醛固酮和血清肌酐在尖端后降低（-36％，P <0.005; -65％，P <0.05; -90％，P <0.005;和-13％，P <0.005 ， 分别）。超声心动图揭示了提示后心功能的微妙变化，但这些是在正常范围内。提示通过增加CO和SV来增加CBV，而HR最初是未置换的。这些结果表明，无法响应于血液动力学挑战而增加心率，这仅部分增加了尖端后CBV。然而，这些变化足以改善肾功能。

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