Furushima Hiroyuki, Ito Shyuji, Sakabe Shunichi, Kanai Eichi, Yamauchi Masayoshi
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Daisan Hospital, Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae, Tokyo 201-8601, Japan.
Nihon Arukoru Yakubutsu Igakkai Zasshi. 2003 Aug;38(4):321-34.
Hepatic and splenic volumes were measured by computed tomography in 43 patients with alcoholic liver cirrhosis (AL-LC), 10 patients with HBs antigen-positive liver cirrhosis (B-LC), 6 patients with HCV associated liver cirrhosis (C-LC) and 6 healthy subjects. Hepatic volume was significantly larger in the patients with AL-LC than in those with B-LC, those with C-LC or healthy subjects. Hepatic volume in patients with AL-LC was also significantly larger in the anti-HBc antibody (anti-HBc)-negative patients than in the anti-HBc-positive patients. This data suggests HBV occult infection may decrease hepatic volume. Hepatic volume showed significantly positive correlations with serum levels of total bilirubin (T. bil), gamma-GTP, type IV collagen levels, continuing alcohol intake and Child-Pugh score, and also showed significant negative correlation with cumulative alcohol intake and prothrombin time (PT). Splenic volume showed significantly positive correlations with serum levels of T. bil and Child-Pugh score, and also showed significantly negative correlations with serum albumin, PT, platelet count and BCAA (branched chain amino acids)/tyrosine ratio. Stepwise logistic regression analysis showed that enlarged hepatic volume, presence of hepatocellular carcinoma and elevated serum gamma-GTP were independently significant risk factors for the development of hepatic failure. Serial determination of hepatic and splenic volume may be useful for the estimation of liver function and prognosis in the patients with AL-LC.
通过计算机断层扫描测量了43例酒精性肝硬化（AL-LC）患者、10例乙肝表面抗原阳性肝硬化（B-LC）患者、6例丙型肝炎病毒相关性肝硬化（C-LC）患者及6名健康受试者的肝脏和脾脏体积。AL-LC患者的肝脏体积显著大于B-LC患者、C-LC患者及健康受试者。AL-LC患者中，抗乙肝核心抗体（anti-HBc）阴性患者的肝脏体积也显著大于anti-HBc阳性患者。该数据提示乙肝病毒隐匿感染可能会减小肝脏体积。肝脏体积与血清总胆红素（T. bil）水平、γ-谷氨酰转肽酶（gamma-GTP）、IV型胶原水平、持续饮酒量及Child-Pugh评分呈显著正相关，与累积饮酒量及凝血酶原时间（PT）呈显著负相关。脾脏体积与血清T. bil水平及Child-Pugh评分呈显著正相关，与血清白蛋白、PT、血小板计数及支链氨基酸（BCAA）/酪氨酸比值呈显著负相关。逐步逻辑回归分析显示，肝脏体积增大、存在肝细胞癌及血清gamma-GTP升高是肝衰竭发生的独立显著危险因素。对肝脏和脾脏体积进行连续测定可能有助于评估AL-LC患者的肝功能及预后。
