Hyperdynamic Circulation in portal Hypertension : Pathophysiology and Effects of Vasoactive Substances

门静脉高压症的高动力循环：病理生理学和血管活性物质的作用

• 批准号: 08670636
• 负责人: IWAO Tadashi
• 金额: $ 0.9万
• 依托单位: Kurume University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1996
• 资助国家: 日本
• 起止时间: 1996 至 1998
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-08670636/
• 关键词: Portal hypertension; Liver cirrhosis; Hemodynamics; Esophageal varices; Vasoactive agents; Meal ingestion; Postural change; Circadian rhythm; 超音波ドプラー; プロプラノロール; ナトリウム利尿ホルモン; 超音波ドップラー; 門脈圧; バソプレッシン

1. Pathophysiology of Hyperdynamic Circulation in Cirrhosis and Portal Hypertension(1) Hemodynamic characteristics in various vascular bedsPeripheral arterial vasodilatation which plays an important role in the initiation of hyperdynamic circulation occurred mainly in the splanchnic circulation. Glucagon and atrial natriuretic peptide contributed to this phenomenon. Hyperdynamic splanchnic circulation developed as liver disease progresses. However, portal outflow pattern was different in patients with esophageal varices and patients with gastric varices. Renovascular constriction seen in patients with hepatorenal syndrome was responsible for kidney's homeostatic response to underfilling of the splanchnic arterial circulation. In liver circulation, hepatic arterial buffer response to altered portal blood flow was reduced.(2) Response to physiological stimuliSplanchnic hyperemia was observed after meal ingestion. Recumbent posture also caused similar change associated with increased atri … More al natriuretic peptide levels. Upright posture reduced esophageal variceal blood flow and blunted postprandial splanchnic hyperemia. Thus, meal ingestion and recumbent posture seemed to be risk factors for variceal bleeding. Furthermore, chronological examination showed that plasma atrial natriuretic peptide levels and cyclic guanosine monophosphate level which reflects activation of the guanylate cyclase receptors by the peptide peaked at night. This finding may explain why patients with cirrhosis tend to have esophageal variceal bleeding episodes at night.2. Hemodynamic Effect of Vasoactive Substances in Cirrhosis and Portal HypertensionVasopressin and propranolol decreased splanchnic inflow, resulting in reduction in collateral blood flow. Individual variability of portal pressure response to propranolol was thought to be heterogeneity of the beta-2 adrenoceptor status. Smoking decreased splanchnic blood flow, resulting in reduction in portal blood flow, suggesting that nicotine has potential portal pressure reducing effect. Less

1.肝硬化和门静脉高压的高动力循环的病理生理学(1)各种血管床的血流动力学特征外周动脉血管舒张对于高动力循环的启动起重要作用，主要发生在内脏循环中，胰高血糖素和心房钠尿肽促成了这种现象。随着肝病的进展，内脏循环会出现高动力性，然而，肝病患者的门脉流出模式却有所不同。肝肾综合征患者中出现的食管静脉曲张和胃静脉曲张患者的肾血管收缩是导致肾脏对内脏动脉循环充盈不足的反应的原因。在肝脏循环中，肝动脉对门脉血流的缓冲反应降低。生理刺激进食后观察到内脏充血，卧姿也会引起与心房增加相关的类似变化。直立姿势会减少食管静脉曲张血流量，并减弱餐后内脏充血，因此，进食和卧姿似乎是静脉曲张出血的危险因素。此外，按时间顺序检查显示血浆心房钠尿肽水平和环磷酸鸟苷水平。肽对鸟苷酸环化酶受体的激活反映在夜间达到峰值。解释为什么肝硬化患者容易在夜间发生食管静脉曲张出血。2．血管活性物质对肝硬化和门脉高压的血流动力学影响加压素和普萘洛尔减少内脏流入，导致门静脉压力对普萘洛尔反应的个体差异。被认为是β2肾上腺素受体状态的异质性，吸烟减少了内脏血流量，导致门静脉血流量减少，提示尼古丁具有潜在的降低门静脉压力的作用。

项目成果

Tadashi Iwao: "Postprandial splanchnic hemodynamic response in patients with cirrhosis of the liver : evaluation with "triple-vessedl" duplex US." Radiology. 201(3). 711-715 (1996)

Tadashi Iwao：“肝硬化患者的餐后内脏血流动力学反应：用“三血管”双功能超声进行评估。”

Tadashi Iwao, Atsushi Toyonaga, Kazuhiko Oho, Hiroyuki Shigemori, Teruhiro Sakai, Chizuru Tayama, Hideo Masumoto, Masahiro Sato and Kyuichi Tanikawa: "Effect of vasopressin on esophageal varices blood flow in patients with cirrhosis : comparisons with the

Tadashi Iwao、Atsushi Toyonaga、Kazuhiko Oho、Hiroyuki Shigemori、Teruhiro Sakai、Chizuru Tayama、Hideo Masumoto、Masahiro Sato 和 Kyuichi Tanikawa：“加压素对肝硬化患者食管静脉曲张血流的影响：与

Keita Nakahara: "Effects of glucagon on superior mesenteric artery and femoral artery hemodynamics in controls and patients with cirrhosis." Eutopean Journal of Gastroenterology and Hepatology. 9. 1233-1237 (1997)

Keita Nakahara：“胰高血糖素对对照组和肝硬化患者肠系膜上动脉和股动脉血流动力学的影响。”

Tadashi Iwao: "Effect of posture-induced blood volume expansion on systemic and regional hemodynamics in patients with cirrhosis." Journal of Hepatology. 27(3). 484-491 (1997)

Tadashi Iwao：“姿势引起的血容量扩张对肝硬化患者全身和局部血流动力学的影响。”

Ryoichi Nakano, Tadashi Iwao, Kazuhiko Oho, Atsushi Toyonaga, and Kyuichi Tanikawa: "Splanchnic hemodynamic pattern and liver function in patients with cirrhosis and esophageal or gastric varices" The American Journal of Gastroenterology. 92. 2085-2089 (1

Ryoichi Nakano、Tadashi Iwao、Kazuhiko Oho、Atsushi Toyonaga 和 Kyuichi Tanikawa：“肝硬化和食管或胃静脉曲张患者的内脏血流动力学模式和肝功能”美国胃肠病学杂志。