Tai D, Changchien C S, Chen C J, Chiou S S, Lee C M, Kuo C H, Chen J J, Chiu K W, Chuah S K, Hu T H
Liver Unit, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan, Republic of China.
Am J Gastroenterol. 1996 Mar;91(3):545-50.
Portal hypertension may develop in patients with severe acute hepatitis. Sequential changes of portal venous hemodynamics in acute hepatitis is not well understood. This study evaluated portal hemodynamic changes and prognostic values in patients with severe, acute hepatitis.
Doppler studies, liver function tests, and virology studies were done in the inclusion, the 3rd month, and the 6th month for patients with severe, acute hepatitis. An indocyanine green clearance was done in the inclusion. Doppler portal hemodynamic studies were done in the hilar area by an average of two measurements.
A total of 88 consecutive patients was included. Nine of them died. On initial study, fatalities were generally older patients with more delayed indocyanine green clearance, lower portal vein velocity, lower albumin values, higher bilirubin values, longer prothrombin time, and ascites. Using stepwise logistic regression, portal blood flow and prothrombin time were the two independence prognostic factors. By multiple linear regression, portal blood flow was associated with ascites, and average portal blood velocity was associated with bilirubin. During the hospital days, transient, depressed portal blood velocities followed by a hyperdynamic stage were found in survivors. The portal vein velocity changes for fatalities either were kept at a lower level or had a declining pattern.
Doppler ultrasound detects portal hemodynamic changes for patients with severe, acute hepatitis. Sequential portal hemodynamic studies will be helpful for evaluating patients with severe, acute hepatitis.
严重急性肝炎患者可能会出现门静脉高压。急性肝炎门静脉血流动力学的连续变化尚未完全清楚。本研究评估了严重急性肝炎患者的门静脉血流动力学变化及其预后价值。
对严重急性肝炎患者在纳入时、第3个月和第6个月进行多普勒检查、肝功能检查和病毒学检查。纳入时进行吲哚菁绿清除率检查。在肝门区域进行多普勒门静脉血流动力学研究，平均测量两次。
共纳入88例连续患者。其中9例死亡。在初始研究中，死亡患者通常为年龄较大者，吲哚菁绿清除延迟更明显，门静脉速度更低，白蛋白值更低，胆红素值更高，凝血酶原时间更长，且有腹水。采用逐步逻辑回归分析，门静脉血流量和凝血酶原时间是两个独立的预后因素。通过多元线性回归分析，门静脉血流量与腹水相关，平均门静脉血流速度与胆红素相关。在住院期间，存活患者出现短暂的门静脉血流速度降低，随后进入高动力阶段。死亡患者的门静脉速度变化要么维持在较低水平，要么呈下降趋势。
多普勒超声可检测严重急性肝炎患者的门静脉血流动力学变化。连续的门静脉血流动力学研究将有助于评估严重急性肝炎患者。
