Imamura H, Kawasaki S, Bandai Y, Sanjo K, Idezuki Y
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
J Hepatol. 1994 Aug;21(2):167-73. doi: 10.1016/s0168-8278(05)80390-3.
To examine whether structural changes in hepatocytes and/or sinusoidal areas contribute to the portal hypertensive state in non-alcoholic cirrhosis, a new method of morphometric analysis using a computer-aided color image analyzer was performed in 16 patients with non-alcoholic cirrhosis, which allowed quantitative evaluation of various morphometric parameters of sinusoids and hepatocytes. The sinusoidal pressure gradient was estimated theoretically with these and clearance parameters using Poiseulle's equation and compared with the hepatic venous pressure gradient measure by hepatic vein cannulation. A significant relationship was found between the hepatic venous pressure gradient and sinusoidal volumetric ratio (r = -0.598, p < 0.05), but not between mean hepatocyte volume and sinusoidal volumetric ratio (r = 0.416, NS), or the hepatic venous pressure gradient (r = 0.371, NS). The estimated sinusoidal pressure gradient showed a significant relationship with the hepatic venous pressure gradient (r = 0.637, p < 0.01). However, the absolute values of the former were much lower than those of the latter. Therefore, in non-alcoholic cirrhosis, although sinusoidal stenosis not caused by hepatocyte swelling may lead to increased vascular resistance, other factors must also play a significant role.
为了研究肝细胞和/或肝血窦区域的结构变化是否导致非酒精性肝硬化门静脉高压状态，我们使用计算机辅助彩色图像分析仪对16例非酒精性肝硬化患者进行了一种新的形态计量学分析方法，该方法可对肝血窦和肝细胞的各种形态计量学参数进行定量评估。利用泊肃叶方程通过这些参数和清除参数从理论上估算肝血窦压力梯度，并与通过肝静脉插管测量的肝静脉压力梯度进行比较。发现肝静脉压力梯度与肝血窦容积比之间存在显著相关性（r = -0.598，p < 0.05），但平均肝细胞体积与肝血窦容积比之间（r = 0.416，无统计学意义）或肝静脉压力梯度之间（r = 0.371，无统计学意义）均无相关性。估算的肝血窦压力梯度与肝静脉压力梯度呈显著相关性（r = 0.637，p < 0.01）。然而，前者的绝对值远低于后者。因此，在非酒精性肝硬化中，尽管非肝细胞肿胀引起的肝血窦狭窄可能导致血管阻力增加，但其他因素也必定起重要作用。
