Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
Gut Liver. 2018 Sep 15;12(5):555-561. doi: 10.5009/gnl17342.
BACKGROUND/AIMS: Acute hepatic dysfunction combined with alcoholic hepatitis (AH) in alcoholic cirrhosis is related to hepatic hypo-perfusion secondary to intrahepatic necroinflammation, neoangiogenesis, and shunt. The hepatic vein arrival time (HVAT) assessed by microbubble contrast-enhanced ultrasonography (CEUS) is closely correlated with the severity of intrahepatic changes. We investigated the usefulness of HVAT to predict short-term mortality of AH in cirrhosis.
Thirty-nine patients with alcoholic cirrhosis (27 males) and AH were prospectively enrolled. HVAT study was performed within 3 days after admission using ultrasonic contrast (SonoVue). The primary outcome was 12-week mortality.
Twelve-week mortality developed in nine patients. HVAT was significantly different between the mortality and survival groups (9.3±2.0 seconds vs 12.6±3.5 seconds, p=0.002). The odds ratio of a shortened HVAT for 12-week mortality was 1.481 (95% confidence interval, 1.050-2.090; p=0.025). The area under the receiver operating characteristic curve of HVAT for 12-week mortality was 0.787 (p=0.010). The combination of MDF and HVAT ≥11.0 seconds resulted in an 87.5% survival rate even if the MDF score ≥32; however, HVAT ＜11.0 seconds was related with mortality despite a MDF score＜32.
HVAT using microbubble CEUS could be a useful additional index to predict short-term mortality in patients with AH and cirrhosis.
背景/目的：酒精性肝硬化合并急性肝损伤和酒精性肝炎（AH）与肝内坏死性炎症、新生血管形成和分流引起的肝低灌注有关。超声造影（CEUS）微泡技术评估的肝静脉到达时间（HVAT）与肝内变化的严重程度密切相关。我们研究了 HVAT 预测肝硬化 AH 短期死亡率的价值。
前瞻性纳入 39 例酒精性肝硬化（27 例男性）合并 AH 患者。入院后 3 天内使用超声造影剂（SonoVue）进行 HVAT 研究。主要结局为 12 周死亡率。
9 例患者在 12 周内死亡。死亡率组与生存率组的 HVAT 差异有统计学意义（9.3±2.0 秒 vs 12.6±3.5 秒，p=0.002）。HVAT 缩短对 12 周死亡率的比值比为 1.481（95%可信区间，1.050-2.090；p=0.025）。HVAT 预测 12 周死亡率的受试者工作特征曲线下面积为 0.787（p=0.010）。即使 MDF 评分≥32，MDF 和 HVAT≥11.0 秒的联合可使生存率达到 87.5%；但 HVAT＜11.0 秒与死亡率相关，即使 MDF 评分＜32。
CEUS 微泡技术的 HVAT 可作为预测 AH 合并肝硬化患者短期死亡率的有用附加指标。
