Zoli M, Magalotti D, Bianchi G, Ghigi G, Orlandini C, Grimaldi M, Marchesini G, Pisi E
Istituto di Clinica Medica Generale e Terapia Medica, University of Bologna, Italy.
J Hepatol. 1995 Aug;23(2):129-34. doi: 10.1016/0168-8278(95)80326-2.
Functional hepatic flow and total hepatic flow were determined by non-invasive techniques in 32 patients with cirrhosis and in 32 paired control subjects. Functional hepatic flow was measured by the hepatic clearance of D-sorbitol, while total hepatic flow was determined by pulsed echo-Doppler, as the sum of portal and hepatic arterial blood flow. Functional hepatic flow was significantly reduced in patients with cirrhosis (927 +/- 314 vs. 1287 +/- 315; p < 0.0001), while total hepatic flow was slightly increased (1511 +/- 540 vs. 1261 +/- 321 in controls; p = 0.028). In control subjects functional hepatic flow significantly correlated with total hepatic flow (r = 0.823; p < 0.001), while no correlation was observed in cirrhosis. Functional hepatic flow and the difference between total hepatic flow and functional hepatic flow significantly correlated with the Child-Pugh score in patients with cirrhosis. The data obtained in control subjects support the measurement of functional hepatic flow and total hepatic flow by non-invasive techniques. The finding that in cirrhosis functional hepatic flow is significantly decreased, while Doppler-assessed total hepatic flow is preserved or even increased, confirms that a relevant part of blood flowing through the liver is diverted by intrahepatic shunts. The simultaneous assessment of these two parameters by non-invasive techniques may be proposed as a reliable tool for the study of functional shunting of cirrhosis.
采用非侵入性技术测定了32例肝硬化患者及32例配对对照者的功能性肝血流和总肝血流。通过D-山梨醇的肝清除率来测量功能性肝血流，而总肝血流则通过脉冲回声多普勒测定，即门静脉和肝动脉血流之和。肝硬化患者的功能性肝血流显著降低（927±314 vs. 1287±315；p<0.0001），而总肝血流略有增加（对照组为1511±540 vs. 1261±321；p = 0.028）。在对照者中，功能性肝血流与总肝血流显著相关（r = 0.823；p<0.001），而在肝硬化患者中未观察到相关性。肝硬化患者的功能性肝血流以及总肝血流与功能性肝血流的差值与Child-Pugh评分显著相关。在对照者中获得的数据支持采用非侵入性技术测量功能性肝血流和总肝血流。肝硬化患者功能性肝血流显著降低而多普勒评估的总肝血流保持不变甚至增加这一发现，证实流经肝脏的一部分血液被肝内分流所分流。通过非侵入性技术同时评估这两个参数可作为研究肝硬化功能性分流的可靠工具。
