Hartleb M, Kloc T, Becker A, Mańczyk I, Bołdys H
Department of Gastroenterology, Silesian Medical School, Katowice, Poland.
Acta Med Hung. 1992;49(1-2):17-28.
Interrelationships between quantitative assessment of portal (%Qp) and arterial (%Qa) components of hepatic blood supply obtained by dynamic hepatoscintigraphy, and clinical variables characterizing the severity of liver cirrhosis and portal hypertension were studied in 25 cirrhotic patients. The variables, clinical state, size of oesophageal varices, ascites accumulation, sonographic stigmata of portal hypertension, liver mass and elimination rate of lidocaine and antipyrine were studied. The %Qa rose in proportion to the severity of liver injury estimated from the Child-Turcotte and McCormick grading scores. The mean %Qa for patients with Child A cirrhosis was significantly higher than that for 8 healthy subjects (34.8 +/- 7.9% vs 18.1 +/- 4.0; P < 0.01). The %Qp values showed relationship with the size of esophageal varices, provided discriminatory data with respect to the ascitic fluid accumulation and the development of intraabdominal collateral circulation. The liver mass had no impact on hepatic dual blood supply pattern, but was linked with the rate of antipyrine clearance. Neither antipyrine clearance nor lidocaine elimination rate corresponded to alterations of hepatic dual blood supply. The %Qp showed a negative correlation with the initial half-life of lidocaine, which was referred to lowered hepatic uptake of the drug. It is concluded that the quantitative assessment of %Qp and %Qa reflect the advancement of portal hypertension better than liver function failure does.
对25例肝硬化患者进行了研究，探讨通过动态肝闪烁显像获得的肝脏血液供应门静脉成分（%Qp）和动脉成分（%Qa）的定量评估与表征肝硬化和门静脉高压严重程度的临床变量之间的相互关系。研究的变量包括临床状态、食管静脉曲张大小、腹水积聚、门静脉高压的超声特征、肝脏质量以及利多卡因和安替比林的消除率。%Qa与根据Child-Turcotte和McCormick分级评分估计的肝损伤严重程度成比例升高。Child A级肝硬化患者的平均%Qa显著高于8名健康受试者（34.8±7.9%对18.1±4.0；P<0.01）。%Qp值与食管静脉曲张大小相关，为腹水积聚和腹腔内侧支循环的发展提供了鉴别数据。肝脏质量对肝脏双重血液供应模式没有影响，但与安替比林清除率有关。安替比林清除率和利多卡因消除率均与肝脏双重血液供应的改变无关。%Qp与利多卡因的初始半衰期呈负相关，这表明肝脏对该药物的摄取降低。结论是，%Qp和%Qa的定量评估比肝功能衰竭更能反映门静脉高压的进展情况。
