Rector W G, Hoefs J C, Hossack K F, Everson G T
Department of Medicine, Denver General Hospital, Colorado 80204-4507.
Hepatology. 1988 Jan-Feb;8(1):16-20. doi: 10.1002/hep.1840080105.
Six of 85 patients (7%) with alcoholic liver disease undergoing transhepatic portal pressure measurement had either stagnant (3 patients) or reversed (3 patients) portal blood flow documented by gentle hand injection of 1 to 2 ml of angiographic contrast. Portal blood flow was uniformly hepatopetal in 24 patients with nonalcoholic liver disease. Recurrent spontaneous hepatic encephalopathy and sodium retention occurred in 4 of 6 patients with stagnant or reversed portal flow; gastrointestinal bleeding was not seen. Standard laboratory tests of liver function were widely variable. Net portal pressure was lower in this group than in patients with alcoholic liver disease and forward portal flow (9.2 +/- 2.6 vs. 15.6 +/- 4.1 mm Hg, p less than 0.001). Wedged hepatic vein pressure was 1 to 7 mm Hg higher than portal vein pressure in patients with reversed portal flow. The arterioportal extraction of bile acid was calculated from the difference in concentration between artery and portal vein, and total functional hepatic blood flow was calculated from the hepatic extraction and systemic clearance of indocyanine green. Extraction was 0%, and hepatic blood flow was 0.469 liter per min in a patient with hepatofugal portal flow and recurrent encephalopathy. Extraction was 20%, and hepatic blood flow was 4.014 liters per min in a patient who had never had encephalopathy. These data indicate that arterioportal communications may be sinusoidal or presinusoidal in patients who lose forward portal flow and that the amount of flow in the arterioportal circuit, together with its efficiency, largely determine the clinical outcome.
85例接受经肝门静脉压力测量的酒精性肝病患者中，有6例（7%）经向门静脉缓慢注入1至2毫升血管造影剂显示门静脉血流停滞（3例）或逆流（3例）。24例非酒精性肝病患者的门静脉血流均为向肝血流。6例门静脉血流停滞或逆流的患者中有4例出现反复自发性肝性脑病和钠潴留；未观察到胃肠道出血。肝功能的标准实验室检查结果差异很大。该组患者的门静脉净压力低于酒精性肝病且门静脉血流正常的患者（9.2±2.6对15.6±4.1毫米汞柱，p<0.001）。门静脉血流逆流的患者肝静脉楔压比门静脉压高1至7毫米汞柱。从动脉和门静脉之间的浓度差计算胆汁酸的动门静脉摄取量，并从吲哚菁绿的肝摄取和全身清除率计算总功能性肝血流量。一名门静脉血流离肝且反复发生脑病的患者摄取率为0%，肝血流量为每分钟0.469升。一名从未发生过脑病的患者摄取率为20%，肝血流量为每分钟4.014升。这些数据表明，门静脉血流向前丧失的患者，动门静脉交通可能是窦状或窦前的，动门静脉循环中的血流量及其效率在很大程度上决定了临床结果。
