Piecha Felix, Peccerella Teresa, Bruckner Tom, Seitz Helmut-Karl, Rausch Vanessa, Mueller Sebastian
Department of Medicine, Salem Medical Center and Center for Alcohol Research and Liver Disease, University of Heidelberg, Heidelberg, Germany; and.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Am J Physiol Gastrointest Liver Physiol. 2016 Nov 1;311(5):G945-G953. doi: 10.1152/ajpgi.00399.2015. Epub 2016 Jun 10.
Noninvasive measurement of liver stiffness (LS) has been established to screen for liver fibrosis. Since LS is also elevated in response to pressure-related conditions such as liver congestion, this study was undertaken to learn more about the role of arterial pressure on LS. LS was measured by transient elastography (μFibroscan platform, Echosens, Paris, France) during single intravenous injections of catecholamines in anesthetized rats with and without thioacetamide (TAA)-induced fibrosis. The effect of vasodilating glycerol trinitrate (GTN) on LS was also studied. Pressures in the abdominal aorta and caval and portal veins were measured in real time with the PowerLab device (AD Instruments, Dunedin, New Zealand). Baseline LS values in all rats (3.8 ± 0.5 kPa, n = 25) did not significantly differ from those in humans. Epinephrine and norepinephrine drastically increased mean arterial pressure (MAP) from 82 to 173 and 156 mmHg. Concomitantly, LS almost doubled from 4 to 8 kPa, while central venous pressure remained unchanged. Likewise, portal pressure only showed a slight and delayed increase. In the TAA-induced fibrosis model, LS increased from 9.5 ± 1.0 to 25.6 ± 14.7 kPa upon epinephrine injection and could efficiently be decreased by GTN. We finally show a direct association in humans in a physiological setting of elevated cardiac output and MAP. During continuous spinning at 200 W, MAP increased from 84 ± 8 to 99 ± 11 mmHg while LS significantly increased from 4.4 ± 1.8 to 6.7 ± 2.1 kPa. In conclusion, our data show that arterial pressure suffices to increase LS. Moreover, lowering MAP efficiently decreases LS in fibrotic livers that are predominantly supplied by arterial blood.
肝脏硬度(LS)的无创测量已被用于筛查肝纤维化。由于LS在诸如肝淤血等与压力相关的情况下也会升高,因此开展本研究以进一步了解动脉压对LS的作用。在麻醉的大鼠中,通过瞬时弹性成像(μFibroscan平台,Echosens,法国巴黎)在单次静脉注射儿茶酚胺期间测量LS,这些大鼠分为有和没有硫代乙酰胺(TAA)诱导纤维化两组。还研究了血管扩张剂硝酸甘油(GTN)对LS的影响。使用PowerLab设备(AD Instruments,新西兰达尼丁)实时测量腹主动脉、腔静脉和门静脉的压力。所有大鼠的基线LS值(3.8±0.5 kPa,n = 25)与人类的基线值无显著差异。肾上腺素和去甲肾上腺素使平均动脉压(MAP)从82急剧升高至173和156 mmHg。与此同时,LS几乎翻倍,从4 kPa升至8 kPa,而中心静脉压保持不变。同样,门静脉压力仅出现轻微且延迟的升高。在TAA诱导的纤维化模型中,注射肾上腺素后LS从9.5±1.0 kPa增加至25.6±14.7 kPa,而GTN可有效降低LS。我们最终在心脏输出量和MAP升高的生理环境中证实了人类存在直接关联。在以200 W持续旋转期间,MAP从84±8 mmHg增加至99±11 mmHg,而LS从4.4±1.8 kPa显著增加至6.7±2.1 kPa。总之,我们的数据表明动脉压足以升高LS。此外,降低MAP可有效降低主要由动脉血供应的纤维化肝脏的LS。