Pugliese D, Ohnishi K, Tsunoda T, Sabba C, Albano O
First Department of Medicine, Chiba University School of Medicine, Japan.
Am J Gastroenterol. 1987 Oct;82(10):1052-6.
Changes of portal, superior mesenteric, and splenic venous flows after a meal were studied with the duplex ultrasonic Doppler flowmeter in normal subjects, in patients with chronic active hepatitis, and in those with cirrhosis for 2 h after ingestion of a liquid meal (14% protein, 56% lipid, 30% carbohydrate, 300 kcal). Portal and superior mesenteric venous flows increased significantly throughout the experiment, whereas no significant change occurred in splenic venous flow after the meal in all three groups. The extent of the increase in portal venous flow was significantly lower in patients with cirrhosis, compared with normal subjects and patients with chronic active hepatitis, whereas superior mesenteric venous flow increased to the same extent in all three groups. The sum of superior mesenteric and splenic venous flows was less than the estimated portal venous flow in both normal subjects and patients with chronic active hepatitis; however, this value was greater than the portal venous flow in patients with cirrhosis. The difference widened during postprandial mesenteric hyperemia, indicating an increase of blood flow into the portal-systemic shunts. In conclusion 1) postprandial hyperemia occurs in the intestine, but not in the spleen, to the same extent in patients with chronic active hepatitis or with cirrhosis, as in normal subjects, and 2) a considerable amount of postprandial mesenteric hyperemia bypasses the liver into the systemic circulation of patients with cirrhosis but not in patients with chronic active hepatitis and normal subjects.
采用双功超声多普勒流量计，对正常受试者、慢性活动性肝炎患者和肝硬化患者在摄入流食（14%蛋白质、56%脂质、30%碳水化合物、300千卡）后2小时内门静脉、肠系膜上静脉和脾静脉血流的变化进行了研究。在整个实验过程中，门静脉和肠系膜上静脉血流显著增加，而在所有三组中，餐后脾静脉血流均无显著变化。与正常受试者和慢性活动性肝炎患者相比，肝硬化患者门静脉血流增加的程度显著降低，而肠系膜上静脉血流在所有三组中增加的程度相同。在正常受试者和慢性活动性肝炎患者中，肠系膜上静脉和脾静脉血流之和小于估计的门静脉血流；然而，在肝硬化患者中，该值大于门静脉血流。在餐后肠系膜充血期间，差异增大，表明进入门体分流的血流量增加。总之，1）慢性活动性肝炎患者或肝硬化患者餐后肠道会出现充血，但脾脏不会，程度与正常受试者相同；2）相当一部分餐后肠系膜充血绕过肝脏进入肝硬化患者的体循环，而慢性活动性肝炎患者和正常受试者则不会。
