肝硬化患者脾肾分流/门静脉直径比值与全身血流动力学的关系

Relationships between splenorenal shunt/portal vein diameter ratio and systemic hemodynamics in patients with liver cirrhosis.

作者信息

Chikamori Fumio, Okamoto Hiroshi, Kuniyoshi Nobutoshi

机构信息

Department of Surgery, Kuniyoshi Hospital, Kuniyoshi Hospital, Kochi, Japan.

出版信息

Digestion. 2014;89(2):133-8. doi: 10.1159/000357494. Epub 2014 Feb 7.

DOI:10.1159/000357494

PMID:24513698

Abstract

OBJECTIVES

The purpose of this study was to investigate the relationships between the splenorenal shunt (SRS)/portal vein (PV) diameter ratio (SRS/PV ratio) and systemic hemodynamics in patients with liver cirrhosis.

PATIENTS AND METHODS

Thirty-seven patients with SRS due to liver cirrhosis were included in this study. SRS was evaluated in the retropancreatic space on contrast-enhanced CT and the diameter was measured at the maximum point. Systemic hemodynamics was studied using a thermodilution catheter.

RESULTS

The SRS/PV ratio showed a significant correlation with the cardiac index (p < 0.01), and showed an inverse correlation with the systemic vascular resistance index and the arteriovenous oxygen content difference [C(a-v)O2] (p < 0.01). The Child-Pugh score showed a correlation with the SRS/PV ratio (p < 0.01). The SRS/PV ratio was 0.89 ± 0.52, 1.02 ± 0.51, and 1.74 ± 0.50 in the Child-Pugh A, B, and C classes, respectively. The SRS/PV ratio in the Child-Pugh C class was significantly higher than those in classes A and B (p < 0.01). The plasma ammonia level was 75.3 ± 23.2 in the group with an SRS/PV ratio <1.0 (n = 19) versus 102.6 ± 34.8 in the group with an SRS/PV ratio ≥1.0 (n = 18), and the ratio of encephalopathy was 5% (1/19) in the group with an SRS/PV ratio <1.0 (n = 19) versus 50% (9/18) in the group with an SRS/PV ratio ≥1.0 (n = 18), respectively. The differences between the two groups were statistically significant (p < 0.01).

CONCLUSIONS

We conclude that the increase in the SRS/PV ratio is accompanied by deteriorated liver function, hyperdynamic status, and narrowed C(a-v)O2.

摘要

目的

本研究旨在探讨肝硬化患者脾肾分流（SRS）/门静脉（PV）直径比值（SRS/PV比值）与全身血流动力学之间的关系。

患者与方法

本研究纳入了37例因肝硬化导致SRS的患者。在对比增强CT上于胰后间隙评估SRS，并在最大点测量其直径。使用热稀释导管研究全身血流动力学。

结果

SRS/PV比值与心脏指数呈显著正相关（p < 0.01），与全身血管阻力指数和动静脉血氧含量差[C(a-v)O2]呈负相关（p < 0.01）。Child-Pugh评分与SRS/PV比值相关（p < 0.01）。Child-Pugh A、B、C级患者的SRS/PV比值分别为0.89±0.52、1.02±0.51和1.74±0.50。Child-Pugh C级患者的SRS/PV比值显著高于A、B级（p < 0.01）。SRS/PV比值<1.0的组（n = 19）血浆氨水平为75.3±23.2，而SRS/PV比值≥1.0的组（n = 18）为102.6±34.8，SRS/PV比值<1.0的组（n = 19）肝性脑病发生率为5%（1/19），而SRS/PV比值≥1.0的组（n = 18）为50%（9/18）。两组间差异具有统计学意义（p < 0.01）。