Carreras E, Grañena A, Navasa M, Bruguera M, Marco V, Sierra J, Tassies M D, García-Pagán J C, Martí J M, Bosch J
Postgraduate School of Hematology Farreras Valenti, Hospital Clínic, Barcelona, Spain.
Bone Marrow Transplant. 1993 Jan;11(1):21-6.
With the aim of evaluating liver disturbances after BMT in 76 patients, the hepatic venous pressure gradient was measured and a transvenous liver biopsy was performed through the jugular vein. Catheterization was successful in 71 patients (93%). In 11 cases the procedure was performed twice, yielding a total number of 82 studies. In five (6%) liver biopsies were non-evaluable. Complications were rare (7%), minor and reversible. As a result of this procedure, the diagnosis was modified in 45%, with both the diagnosis and treatment being modified in 30% of patients. Veno-occlusive disease (VOD) was histologically demonstrated in 15 out of 26 patients (58%) in whom this complication was suspected and in two out of 33 (6%) in whom it was not. Acute GVHD of the liver was confirmed in 15 out of the 35 patients (43%) in whom this complication was suspected and in four of 24 (17%) in whom it was not. The hepatic venous pressure gradient was significantly higher in VOD than in liver GVHD. Whereas 14/17 (82%) patients with VOD had a gradient pressure higher than 9 mmHg, no patient with GVHD had a gradient above this value. We conclude that transjugular liver biopsy is an effective, safe, and useful technique to evaluate BMT related liver dysfunction.
为评估76例骨髓移植（BMT）后的肝脏紊乱情况，测量了肝静脉压力梯度，并通过颈静脉进行了经静脉肝活检。71例患者（93%）插管成功。11例患者进行了两次该操作，共进行了82次研究。5例（6%）肝活检无法评估。并发症罕见（7%），程度较轻且可逆转。通过该操作，45%的患者诊断得以修正，30%的患者诊断和治疗均得以修正。在怀疑有该并发症的26例患者中，15例（58%）经组织学证实患有肝静脉闭塞病（VOD），在未怀疑有该并发症的33例患者中，2例（6%）患有该病。在怀疑有该并发症的35例患者中，15例（43%）经证实患有肝脏急性移植物抗宿主病（GVHD），在未怀疑有该并发症的24例患者中，4例（17%）患有该病。VOD患者的肝静脉压力梯度显著高于肝脏GVHD患者。14/17（82%）例VOD患者的梯度压力高于9 mmHg，而GVHD患者中没有患者的梯度压力高于此值。我们得出结论，经颈静脉肝活检是评估BMT相关肝功能障碍的一种有效、安全且有用的技术。
