Ohkubo H, Okuda K, Iida S, Ohnishi K, Ikawa S, Makino I
Gastroenterology. 1984 Mar;86(3):514-20.
To study the mechanism for the elevation of serum bile acids in liver cirrhosis, bile acid concentrations were measured in the portal, superior mesenteric, and splenic veins, using percutaneous transhepatic catheterization, and compared with those of peripheral veins in 41 patients with mild to moderately advanced cirrhosis. The demonstrated gradient of bile acid concentration was superior mesenteric vein greater than portal vein greater than peripheral vein nearly equal to splenic vein, suggesting that the superior mesenteric vein is the main route of transport for the intestinally absorbed bile acids. Bile acid concentrations in peripheral vein were correlated with the measured portal and splenic vein shunt indexes. The ursodeoxycholic acid oral tolerance test carried out in 10 patients during portal vein catheterization demonstrated that hepatic extraction of this bile acid was correlated with indocyanine green clearance and that it was inversely correlated with portal vein shunt index. These findings are consistent with the view that distorted hepatic blood flow has a significant role in elevating serum bile acid, at least in patients with moderately advanced liver cirrhosis.
为研究肝硬化患者血清胆汁酸升高的机制，采用经皮经肝导管插入术，测定了41例轻度至中度晚期肝硬化患者门静脉、肠系膜上静脉和脾静脉中的胆汁酸浓度，并与外周静脉的胆汁酸浓度进行比较。结果显示胆汁酸浓度梯度为：肠系膜上静脉＞门静脉＞外周静脉≈脾静脉，提示肠系膜上静脉是肠道吸收胆汁酸的主要运输途径。外周静脉中的胆汁酸浓度与测得的门静脉和脾静脉分流指数相关。在10例患者门静脉插管期间进行的熊去氧胆酸口服耐受性试验表明，该胆汁酸的肝摄取与吲哚菁绿清除率相关，且与门静脉分流指数呈负相关。这些发现与以下观点一致，即至少在中度晚期肝硬化患者中，肝血流紊乱在血清胆汁酸升高方面起重要作用。
