Adams P C, Bradley C, Frei J V
Department of Medicine, University Hospital, University of Western Ontario, London, Canada.
Hepatology. 1994 Jan;19(1):101-5.
Hepatic iron and zinc concentrations were determined in 26 consecutive nonalcoholic cirrhotic patients who had previously undergone portacaval shunting and then liver transplantation and 37 control patients. Stainable iron was graded on a scale of 0 to 4; 11 shunt patients and 3 control patients had grade 2 to 4 iron staining. Mean hepatic iron concentration was significantly increased (20.1 +/- 4.1 mumol/gm) in the shunt group compared with the control group (9.1 +/- 2.3 mumol/gm) (normal value, < 35 mumol/gm) (p = .015, Student's t test). Mean hepatic iron index (hepatic iron/age) was 0.5 +/- 0.10 in the shunt group and 0.19 +/- 0.04 in the control group (p = 0.002). One shunt patient had a hepatic iron index of greater than 2. Hepatic zinc was not significantly different between the shunt group (2.42 +/- 0.18 mumol/gm) and the control group (2.56 +/- 0.14 mumol/gm). Serial biopsy specimens were analyzed in 17 cases (6 shunt, 11 controls), and the mean annual rate of iron accumulation was significantly greater in shunt patients (4.75 mumol/gm/yr) than in control cases (0.93 mumol/gm/yr, p = 0.037). Although increased stainable iron was common after portacaval shunting, quantitative iron analysis demonstrated increased hepatic iron concentrations in only 6 of 26 shunt patients and 3 of 37 control patients (p = 0.14, chi 2 test). Quantitative hepatic iron analysis demonstrated in this study that portacaval shunt patients have far less accumulated iron than hemochromatosis patients and are unlikely to have tissue injury resulting from iron overload.
对26例曾接受门腔分流术并随后接受肝移植的非酒精性肝硬化患者以及37例对照患者测定了肝脏铁和锌的浓度。可染色铁按0至4级分级；11例分流患者和3例对照患者的铁染色为2至4级。与对照组（9.1±2.3μmol/g）（正常值，<35μmol/g）相比，分流组的平均肝脏铁浓度显著升高（20.1±4.1μmol/g）（p = 0.015，Student t检验）。分流组的平均肝脏铁指数（肝脏铁/年龄）为0.5±0.10，对照组为0.19±0.04（p = 0.002）。1例分流患者的肝脏铁指数大于2。分流组（2.42±0.18μmol/g）和对照组（2.56±0.14μmol/g）的肝脏锌含量无显著差异。对17例患者（6例分流患者，11例对照患者）的系列活检标本进行了分析，分流患者的铁蓄积平均年速率（4.75μmol/g/年）显著高于对照患者（0.93μmol/g/年，p = 0.037）。尽管门腔分流术后可染色铁增加很常见，但定量铁分析显示，26例分流患者中只有6例、37例对照患者中只有3例肝脏铁浓度升高（p = 0.14，卡方检验）。本研究中的定量肝脏铁分析表明，门腔分流患者的铁蓄积远少于血色素沉着症患者，不太可能因铁过载导致组织损伤。
