Kadohara M, Kawasaki H, Hirayama C
Second Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Gastroenterol Jpn. 1987 Oct;22(5):614-20. doi: 10.1007/BF02776722.
The purpose of this study was to compare the endoscopic findings based on the general rules for recording endoscopic findings on esophageal varices by the Japanese Research Society for Portal Hypertension with liver function tests including serum bile acids and bile acid clearance tests in 64 patients with liver cirrhosis. Cases of esophageal varices showed significantly higher serum bile acid levels and greater ICG retention than those without esophageal varices. The oral ursodeoxycholic acid tolerance test was significantly impaired in the group with esophageal varices (p less than 0.05). In cases with esophageal varices, there was no significant difference in serum bile acid levels between white and blue varix patients, while serum bile acid levels in the red-color sign-positive group were significantly higher than those in the negative group (p less than 0.01). Serum bile acid levels increased in parallel with the form of varices as reflected by the shape and size of varices and with the location of varices which reflects the longitudinal-extent of varices. These results indicate that the impaired clearance of serum bile acids in liver cirrhosis is closely related with the red-color sign on the variceal surface and with the form and location of esophageal varices, which may reflect the grade of portal-systemic shunting.
本研究旨在比较64例肝硬化患者中，依据日本门静脉高压研究学会食管静脉曲张内镜检查结果记录总则得出的内镜检查结果，与包括血清胆汁酸和胆汁酸清除试验在内的肝功能检查结果。食管静脉曲张患者的血清胆汁酸水平显著高于无食管静脉曲张者，吲哚菁绿潴留情况也更严重。食管静脉曲张组的口服熊去氧胆酸耐量试验明显受损（p小于0.05）。在食管静脉曲张病例中，白色和蓝色静脉曲张患者的血清胆汁酸水平无显著差异，而红色征阳性组的血清胆汁酸水平显著高于阴性组（p小于0.01）。血清胆汁酸水平随静脉曲张的形态（由静脉曲张的形状和大小反映）以及静脉曲张的位置（反映静脉曲张的纵向范围）而平行升高。这些结果表明，肝硬化患者血清胆汁酸清除受损与静脉曲张表面的红色征以及食管静脉曲张的形态和位置密切相关，这可能反映了门体分流的程度。
