CLINICAL-SIGNIFICANCE OF THE EVALUATION OF HEPATIC RETICULOENDOTHELIAL REMOVAL CAPACITY IN PATIENTS WITH CIRRHOSIS
CLINICAL-SIGNIFICANCE OF THE EVALUATION OF HEPATIC RETICULOENDOTHELIAL REMOVAL CAPACITY IN PATIENTS WITH CIRRHOSIS
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DOI：
10.1002/hep.1840190313
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发表时间：
1994-03-01
期刊：
影响因子：
13.5
通讯作者：
GATTA, A
中科院分区：
文献类型：
--
作者：
BOLOGNESI, M;MERKEL, C;GATTA, A
网状内皮系统在预防肝硬化患者细菌感染方面发挥着重要作用。然而，关于其在此类患者中的活性的数据很少。本研究的目的是在研究Tc-99m微球增量去除动力学的基础上，评估肝硬化患者肝网状内皮系统的最大去除能力，并验证其作为自发性细菌性腹膜炎死亡和发展的预后因素的价值。检测43例肝硬化患者（酒精性肝硬化33例，肝炎后肝硬化8例，隐源性肝硬化2例）的常见临床和生化参数、Pugh评分、最大清除能力、氨基比林代谢能力和半乳糖清除能力。还测量了其中 16 名患者的肝血浆浓度和吲哚菁绿血浆清除率。最大去除能力的参考范围是在七名正常受试者中确定的。 24 名患者 (56%) 的最大清除能力低于正常范围。在整个系列中，最大去除能力平均为 16 +/- 12 μg/kg 体重/分钟（平均值 +/- S.D.）。最大清除能力与血清白蛋白、凝血酶原指数、Pugh评分、氨基比林呼气试验、半乳糖消除能力和吲哚菁绿血浆清除率显着相关，但与肝血浆流量无关。在长达 48 个月的随访期间，6 名患者出现自发性细菌性腹膜炎，全部患者最大摄取能力受损，11 名患者死亡。最大清除能力受损的患者的生存期明显短于最大清除能力正常的患者（对数秩检验：p = 0.024）。此外，最大清除能力受损与自发性细菌性腹膜炎的风险增加相关（对数秩检验：p = 0.037）；当考虑总腹水蛋白浓度时，还发现它是一个独立的预后因素。我们的结论是，肝硬化患者，尤其是晚期疾病患者，通常会出现最大清除能力下降。最大清除能力的受损与自发性细菌性腹膜炎的风险增加相关。
The reticuloendothelial system plays an important role in the prevention of bacterial infection in patients with cirrhosis. Few data are available, however, on its activity in such patients. The aim of this study was to evaluate the maximum removal capacity of hepatic reticuloendothelial system in patients with cirrhosis on the basis of study of the removal kinetics of increasing amounts of Tc-99m millimicrospheres and to verify its value as a prognostic factor for death and development of spontaneous bacterial peritonitis. Common clinical and biochemical parameters, Pugh score, maximum removal capacity, aminopyrine metabolic capacity and galactose elimination capacity were measured in 43 patients with cirrhosis (33 with alcoholic cirrhosis, 8 with posthepatitic cirrhosis and 2 with cryptogenic cirrhosis). Hepatic plasma how and indocyanine green plasma clearance were also measured in 16 of these patients. Reference range of maximum removal capacity was determined in seven normal subjects. Maximal removal capacity below the normal range was found in 24 patients (56%). In the whole series maximum removal capacity averaged 16 +/- 12 mu g/kg body wt/min (mean +/- S.D.). Maximal removal capacity was significantly correlated with serum albumin, prothrombin index, Pugh score, aminopyrine breath test, galactose elimination capacity and indocyanine green plasma clearance but not with hepatic plasma flow. During follow-up of up to 48 mo, spontaneous bacterial peritonitis developed in six patients, all with impaired maximum uptake capacity, and 11 patients died. Survival was significantly shorter in patients with impaired maximum removal capacity than in those with normal maximum removal capacity (log-rank test: p = 0.024). Moreover, impaired maximum removal capacity was associated with increased risk of spontaneous bacterial peritonitis (log-rank test: p = 0.037); it was also found to be an independent prognostic factor when total ascitic fluid protein concentration was taken into account. We conclude that a decrease in maximum removal capacity is often present in patients with cirrhosis, particularly in those with advanced disease. The impairment in maximum removal capacity is associated with increased risk of spontaneous bacterial peritonitis.