Wythe Stephen, Davies Thomas W, O'Beirne James, Martin Daniel, Gilbert-Kawai Edward
University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre Institute of Sport and Exercise Health London UK.
Department of Intensive Care Royal Free Hospital Pond Street London UK.
JGH Open. 2019 May 24;3(6):518-524. doi: 10.1002/jgh3.12196. eCollection 2019 Dec.
Liver cirrhosis is associated with widespread microcirculatory dysfunction and hemodynamic derangement, which may play a role in the pathogenesis of multiple organ failure. Little is known, however, about the progression of microvascular alterations as the severity of liver disease worsens. Therefore, our aim is to quantify the peripheral systemic microcirculatory changes associated with increasing severity of liver cirrhosis.
Forty patients with liver cirrhosis were studied and divided into groups based on Child-Pugh classes A ( = 9), B ( = 18), and C ( = 13) for comparison. Incident dark field imaging was used to evaluate the sublingual microcirculation and near-infrared spectroscopy at the thenar eminence to assess microvascular reactivity and function.
There was no difference in microcirculatory flow index ( = 0.655), heterogeneity index ( = 0.702), or vessel density ( = 0.923) between the different Child-Pugh groups. Microvascular reactivity did not change as the severity of liver disease worsened.
This study showed no association between peripheral systemic microcirculatory alterations and the severity of liver disease. Further research with larger study cohorts are needed to clarify the relationship between microcirculatory abnormalities and disease progression and to establish if the peripheral microcirculation is affected by the pathophysiology of worsening cirrhosis.
肝硬化与广泛的微循环功能障碍和血流动力学紊乱相关，这可能在多器官功能衰竭的发病机制中起作用。然而，关于随着肝病严重程度加重微血管改变的进展情况，人们知之甚少。因此，我们的目的是量化与肝硬化严重程度增加相关的外周全身微循环变化。
对40例肝硬化患者进行研究，并根据Child-Pugh分级A组（=9例）、B组（=18例）和C组（=13例）进行分组比较。采用入射式暗场成像评估舌下微循环，并采用鱼际近红外光谱评估微血管反应性和功能。
不同Child-Pugh组之间的微循环血流指数（=0.655）、异质性指数（=0.702）或血管密度（=0.923）无差异。随着肝病严重程度加重，微血管反应性未发生变化。
本研究表明外周全身微循环改变与肝病严重程度之间无关联。需要更大规模的研究队列进行进一步研究，以阐明微循环异常与疾病进展之间的关系，并确定外周微循环是否受肝硬化病情恶化病理生理学的影响。
