Duvoux Christophe, Radier Catherine, Roudot-Thoraval Françoise, Maille François, Anglade Marie-Christine, Van Nhieu Jeanne Tran, Rosa Isabelle, Hospitel Sylvie, Abd-Alsamad Issam, Sitruk Véronique, Seror Olivier, Ziol Marianne, Blondon Hughes, Dhumeaux Daniel, Richardet Jean-Philippe
Service d'Hépatologie et de Gastroentérologie, Unité de Transplantation Hépatique and INSERM U581, Créteil, France.
Hepatology. 2004 Dec;40(6):1370-8. doi: 10.1002/hep.20475.
The aim of this study was to assess the prevalence and prognostic value of major alterations of portal flow in patients with steroid-treated alcoholic hepatitis. Fifty patients with severe, histologically proven alcoholic hepatitis were enrolled. Clinical data, liver test results, and hepatic Doppler ultrasound findings were collected at inclusion and at month 2. Patients were followed for 1 year or until death. Major changes in portal flow were defined as reversed or alternating flow in the portal trunk and/or in intrahepatic portal branches. Changes in portal flow were observed in 24 (48.0%) of 50 and 17 (39.5%) of 43 patients at inclusion and month 2, respectively. Univariate analysis showed that age older than 50 years, steatosis less than 20% on initial liver biopsy, presence of major changes in portal flow, Child-Turcotte-Pugh score higher than 12, factor V level higher than 45%, and hepatofugal splenic blood flow were associated with a lower 1-year survival. Cox regression analysis showed that steatosis < 20% (relative hazard [RH] = 9.3, P = .0009) and major changes in portal flow (RH = 3.1, P = .04), were independently associated with poor survival. In conclusion, major changes in portal flow are frequent in patients with severe alcoholic hepatitis. Altered portal flow and steatosis < 20% are new prognostic factors in steroid-treated alcoholic hepatitis and must be taken into account in patient management.
本研究的目的是评估接受类固醇治疗的酒精性肝炎患者门静脉血流主要改变的患病率及其预后价值。纳入了50例经组织学证实的重度酒精性肝炎患者。在纳入时和第2个月收集临床数据、肝功能检查结果和肝脏多普勒超声检查结果。对患者进行1年随访或直至死亡。门静脉血流的主要变化定义为门静脉主干和/或肝内门静脉分支出现反向或交替血流。在纳入时和第2个月，50例患者中有24例（48.0%）、43例患者中有17例（39.5%）观察到门静脉血流变化。单因素分析显示，年龄大于50岁、初次肝活检时脂肪变性小于20%、门静脉血流出现主要变化、Child-Turcotte-Pugh评分高于12、凝血因子V水平高于45%以及脾静脉出现离肝血流与1年生存率较低相关。Cox回归分析显示，脂肪变性<20%（相对危险度[RH]=9.3，P=0.0009）和门静脉血流主要变化（RH=3.1，P=0.04）与生存不良独立相关。总之，重度酒精性肝炎患者门静脉血流主要变化很常见。门静脉血流改变和脂肪变性<20%是类固醇治疗的酒精性肝炎新的预后因素，在患者管理中必须予以考虑。
