Bolognesi Massimo, Verardo Alberto, Di Pascoli Marco
Massimo Bolognesi, Alberto Verardo, Marco Di Pascoli, Department of Medicine, University of Padua, Azienda Ospedaliera Università di Padova, 35128 Padova, Italy.
World J Gastroenterol. 2014 Jul 7;20(25):8005-10. doi: 10.3748/wjg.v20.i25.8005.
Alcohol-related cirrhosis is a consequence of heavy and prolonged drinking. Similarly to patients with cirrhosis of other etiologies, patients with alcoholic cirrhosis develop portal hypertension and the hepatic, splanchnic and systemic hemodynamic alterations that follow. However, in alcoholic cirrhosis, some specific features can be observed. Compared to viral cirrhosis, in alcohol-related cirrhosis sinusoidal pressure is generally higher, hepatic venous pressure gradient reflects portal pressure better, the portal flow perfusing the liver is reduced despite an increase in liver weight, the prevalence of reversal portal blood flow is higher, a patent paraumbilical vein is a more common finding and signs of hyperdynamic circulations, such as an increased cardiac output and decreased systemic vascular resistance, are more pronounced. Moreover, alcohol consumption can acutely increase portal pressure and portal-collateral blood flow. Alcoholic cardiomyopathy, another pathological consequence of prolonged alcohol misuse, may contribute to the hemodynamic changes occurring in alcohol-related cirrhosis. The aim of this review was to assess the portal-hepatic changes that occur in alcohol-related cirrhosis, focusing on the differences observed in comparison with patients with viral cirrhosis. The knowledge of the specific characteristics of this pathological condition can be helpful in the management of portal hypertension and its complications in patients with alcohol-related cirrhosis.
酒精性肝硬化是长期大量饮酒的后果。与其他病因所致肝硬化患者类似，酒精性肝硬化患者会出现门静脉高压以及随之而来的肝脏、内脏和全身血流动力学改变。然而，在酒精性肝硬化中，可以观察到一些特定特征。与病毒性肝硬化相比，在酒精性肝硬化中，肝窦压力通常更高，肝静脉压力梯度能更好地反映门静脉压力，尽管肝脏重量增加，但灌注肝脏的门静脉血流减少，门静脉血流逆转的发生率更高，脐旁静脉通畅是更常见的表现，并且高动力循环体征，如心输出量增加和全身血管阻力降低，更为明显。此外，饮酒可急性增加门静脉压力和门体侧支血流。酒精性心肌病是长期酗酒的另一个病理后果，可能导致酒精性肝硬化中出现的血流动力学变化。本综述的目的是评估酒精性肝硬化中发生的门静脉-肝脏变化，重点关注与病毒性肝硬化患者相比所观察到的差异。了解这种病理状况的具体特征有助于管理酒精性肝硬化患者的门静脉高压及其并发症。
