一种测量肝内分流的新方法。

Hoefs J C, Reynolds T B, Pare P, Sakimura I

J Lab Clin Med. 1984 Mar;103(3):446-61.

After transhepatic portal pressure determination, 96 patients were assessed for the presence of intrahepatic shunts by injection of microspheres (25 +/- 5 micron diameter) into the portal vein using RISA-131I as an indicator of dilution. Multiple portal vein injections in each patient allowed blood sampling from the hepatic vein (site 1) and from two inferior vena cava sampling sites (site 2, at the junction of the hepatic vein orifice with the inferior vena cava, and site 3, 2 to 3 cm closer to or within the right atrium). Intrahepatic shunting was calculated from each site: hepatic vein in 57 patients and inferior vena cava, site 2 in 43 patients and site 3 in 77 patients. At least one valid IHS calculation was available in 92 of the patients. Intrahepatic shunting calculated from sequential portal vein injections with sampling from the hepatic vein was highly correlated (r = 0.98, p less than 0.0001, slope = 1.0), with a mean difference of 1.9% +/- 1.9%. There was no significant difference by t test comparison of the mean IHS calculated from sites 1, 2, and 3. The IHShv was correlated with the IHSivc (site 2) (r = 0.79, p less than 0.0001, slope = 1.0) and IHSivc (site 3) (r = 0.82, p less than 0.0001, slope = 2.1). Occasional marked discrepancies were noted between IHS calculated from site 1 or site 2 compared with site 3, and the site 3 calculation was always greater. A shunt index in all patients included shunts calculated from the hepatic vein in 57 patients plus shunt calculation from the inferior vena cava in the remaining patients (site 2 in 26 patients and site 3 in nine). A control group with minimal chronic liver disease (10 patients) had a portal pressure (greater than IVC) of 4.1 +/- 1.4 mm Hg and shunt index of 0.5% +/- 0.6%. The 82 patients with portal hypertension or chronic liver disease had a higher portal pressure, 13.8 +/- 4.6 mm Hg, and a significantly greater shunt index, 13.7% +/- 24.5% (p less than 0.0001) compared with controls. The frequency distribution of IHS in patients with chronic liver disease demonstrated less than 2% IHS in 49% of patients and less than 5% IHS in 63%. The validity of our methods and the implications of the infrequent demonstration of a large IHS are discussed.

在经肝门静脉压力测定后，对96例患者进行了肝内分流的评估，方法是将微球（直径25±5微米）注入门静脉，以131I - 人血清白蛋白（RISA - 131I）作为稀释指标。对每位患者进行多次门静脉注射，以便从肝静脉（部位1）以及下腔静脉的两个采样部位（部位2，在肝静脉开口与下腔静脉的交界处；部位3，距离右心房更近2至3厘米或在右心房内）采集血样。从每个部位计算肝内分流情况：57例患者从肝静脉计算，43例患者从下腔静脉部位2计算，77例患者从下腔静脉部位3计算。92例患者至少有一次有效的肝内分流计算结果。通过从肝静脉采样的连续门静脉注射计算得到的肝内分流与其他计算结果高度相关（r = 0.98，p < 0.0001，斜率 = 1.0），平均差异为1.9%±1.9%。通过t检验比较从部位1、2和3计算得到的肝内分流平均值，差异无统计学意义。肝静脉分流指数（IHShv）与下腔静脉部位2的分流指数（IHSivc）相关（r = 0.79，p < 0.0001，斜率 = 1.0），与下腔静脉部位3的分流指数（IHSivc）相关（r = 0.82，p < 0.0001，斜率 = 2.1）。与部位3相比，从部位1或部位2计算得到的肝内分流偶尔会出现明显差异，且部位3的计算结果总是更大。所有患者的分流指数包括57例患者从肝静脉计算的分流加上其余患者从下腔静脉计算的分流（26例患者从部位2计算，9例患者从部位3计算）。慢性肝病程度较轻的对照组（10例患者）门静脉压力（高于下腔静脉）为4.1±1.4毫米汞柱，分流指数为0.5%±0.6%。与对照组相比，82例门静脉高压或慢性肝病患者的门静脉压力更高，为13.8±4.6毫米汞柱，分流指数显著更高，为13.7%±24.5%（p < 0.0001）。慢性肝病患者肝内分流的频率分布显示，49%的患者肝内分流小于2%，63%的患者肝内分流小于5%。本文讨论了我们方法的有效性以及肝内分流较大情况罕见的意义。