Functional significance of hepatic arterial flow reserve in patients with cirrhosis
Functional significance of hepatic arterial flow reserve in patients with cirrhosis
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肝硬化患者肝动脉血流储备的功能意义
DOI：
10.1053/jhep.2003.50065
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发表时间：
2003
期刊：
影响因子：
13.5
通讯作者：
G. Kleber
中科院分区：
文献类型：
--
作者：
A. Zipprich;Norbert Steudel;C. Behrmann;F. Meiss;U. Sziegoleit;W. Fleig;G. Kleber
在肝硬变中，门静脉血流量减少会导致肝动脉扩张。然而，尽管肝硬变患者的肝动脉血流储备较高，但其对肝功能的影响尚不清楚。本研究探讨了腺苷诱导的肝动脉扩张对不同肝功能指标的影响。对20例肝硬变(ChildPughA/B/C级，n=2/7/11)患者，肝动脉内注入腺苷(2~30μ·g·−·kg·体质量−1)，用数字血管造影和血管内多普勒超声检测肝动脉平均峰值血流速度、搏动指数和血流量。吲哚青绿(ICG)、利多卡因和半乳糖分别以0.5、1.0和500 mg/kg体重的剂量静脉注射，在腺苷诱导的肝动脉扩张的情况下，在单独的研究日，不加腺苷。测定ICG消失率、半乳糖消除能力(GEC)和利多卡因代谢物单乙基甘氨酸二酯(MEGX)的形成。腺苷显著升高APV和HABF，显著降低PI。注射腺苷前后的血清MEGX浓度分别为63.7±18.2(中位数62；范围36-107)和99.0±46.3(82.5；49-198)ng/mL(P=.001)。腺苷诱导的MEGX浓度变化与APV(r=−0.5，P=0.0 2)和PI(r=−0.5 5，P=0.0 1)呈负相关，且C级患者较A级患者更为显著(5 7.4±49.9[44；−14~14 0]vs.8.4±16.5[13；−11~35]ng/mL，P<；0.01)。总之，肝动脉扩张术对肝硬变患者有显著的功能益处。这种效果不直接依赖于肝动脉的大灌注量，在失代偿期疾病的患者中优先观察到。
In cirrhosis, hepatic arterial vasodilatation occurs in response to reduced portal venous blood flow. However, although the hepatic arterial flow reserve is high in patients with cirrhosis, its impact on hepatic function is unknown. This study investigated the effect of adenosine‐induced hepatic arterial vasodilatation on different markers of liver function. In 20 patients with cirrhosis (Child‐Pugh class A/B/C: n = 2/7/11) adenosine (2‐30 μg · min−1 · kg body wt−1) was infused into the hepatic artery and hepatic arterial average peak flow velocities (APV), pulsatility indices (PI), and blood flow volumes (HABF) were measured using digital angiography and intravascular Doppler sonography. Indocyanine green (ICG), lidocaine, and galactose were administered intravenously in doses of 0.5, 1.0, and 500 mg/kg body weight in the presence of adenosine‐induced hepatic arterial vasodilatation and, on a separate study day, without adenosine. ICG disappearance, galactose elimination capacity (GEC), and formation of the lidocaine metabolite monoethylglycinxylidide (MEGX) were assessed. Adenosine markedly increased APV and HABF and markedly decreased PI. Serum MEGX concentrations were 63.7 ± 18.2 (median, 62; range, 36‐107) and 99.0 ± 46.3 (82.5; 49‐198) ng/mL in the absence and presence of adenosine infusion, respectively (P = .001). Adenosine‐induced changes in MEGX concentrations were correlated inversely to changes in APV (r = −0.5, P = .02) and PI (r = −0.55, P = .01) and were more marked in Child‐Pugh class C compared with Child‐Pugh class A patients (57.4 ± 49.9 [44; −14 to 140] vs. 8.4 ± 16.5 [13; −11 to 35] ng/mL, P < .01). In conclusion, hepatic arterial vasodilatation provides substantial functional benefit in patients with cirrhosis. The effect does not depend directly on hepatic arterial macroperfusion and is observed preferentially in patients with decompensated disease.
血浆半乳糖的一级清除：肝脏疾病的影响。
影响因子：
29.4
作者：
Henderson,JM;Kutner,MH;Bain,RP
通讯作者：
Bain,RP