Zacho Helle D, Abrahamsen Jan
Department of Clinical Physiology, Viborg Hospital, Viborg, Denmark.
Clin Physiol Funct Imaging. 2010 Mar;30(2):116-21. doi: 10.1111/j.1475-097X.2009.00912.x. Epub 2009 Nov 24.
The diagnosis chronic intestinal ischaemia (CII) is based on the clinical symptoms postprandial pain and weight loss combined with abnormal findings during angiography. Despite the well-known poor correlation between symptoms and morphology, physiological tests are rarely performed.
It is possible to measure the total splanchnic blood flow (SBF) before and after a test meal, and the results supply additional information to the morphologic investigations. To date, no papers have addressed the impact of morphologic changes of the mesenteric arteries on the SBF.
Forty-six consecutive patients suspected of CII were investigated. The routine investigation included angiography and measurements of the SBF before and after a test meal. Measurements of the total SBF were performed using the 'Fick principle'. (99m)Technetium-labelled Mebrofenin was used as a tracer. Digital subtraction angiography was performed.
Agreement between SBF and angiography was found in 44 of 46 patients. Mean baseline SBF for all patients was 985 ml/min, total range (525-1932) and within the reported normal range. The mean postprandial increase in SBF was 480 mL min(-1) (-130 to 1353), thus 36 patients were categorized as normal by both angiography and SBF, eight patients were abnormal by both methods and two patients had abnormal SBF but normal angiography.
In this cohort, SBF detects CII with sensitivity of 1.0, and specificity of 0.95. SBF supplies additional information in patients with convincing symptoms and normal angiography. In these patients, the affection of the intestinal arteries may be too distant or too subtle to be visualized on angiography.
慢性肠缺血（CII）的诊断基于餐后疼痛和体重减轻等临床症状，以及血管造影检查中的异常发现。尽管症状与形态学之间的相关性较差已为人所知，但生理测试却很少进行。
可以在试餐后测量内脏总血流量（SBF），其结果可为形态学检查提供额外信息。迄今为止，尚无论文探讨肠系膜动脉形态学变化对SBF的影响。
对46例连续怀疑患有CII的患者进行了研究。常规检查包括血管造影以及试餐前后的SBF测量。使用“Fick原理”进行总SBF测量。用（99m）锝标记的美布芬宁作为示踪剂。进行了数字减影血管造影。
46例患者中有44例的SBF与血管造影结果相符。所有患者的平均基线SBF为985 ml/min，总范围为（525 - 1932），在报告的正常范围内。餐后SBF的平均增加量为480 mL·min⁻¹（-130至1353），因此36例患者的血管造影和SBF均分类为正常，8例患者两种方法均异常，2例患者SBF异常但血管造影正常。
在该队列中，SBF检测CII的敏感性为1.0，特异性为0.95。SBF为有明显症状但血管造影正常的患者提供了额外信息。在这些患者中，肠动脉的病变可能距离太远或太细微，无法在血管造影中显现。
