Shiomi S, Sasaki N, Habu D, Takeda T, Nishiguchi S, Kuroki T, Tanaka T, Ochi H
Third Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan.
J Gastroenterol. 1998 Aug;33(4):517-22. doi: 10.1007/s005350050125.
Portal circulation can be evaluated in a relatively noninvasive way by per-rectal portal scintigraphy. We used this method to evaluate portal hemodynamics in patients with chronic liver diseases and underlying hepatic viral infection; the patients did not need surgery or sclerotherapy, or refused it, so changes in the natural course were identified. A solution of Tc-99m pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the liver and heart were produced. The per-rectal portal shunt index was calculated from the curves. In a longitudinal study, 70 patients (9 with mild chronic hepatitis, 10 with moderate chronic hepatitis, 7 with severe chronic hepatitis, 22 with cirrhosis but without varices, and 22 with both cirrhosis and varices) were examined at least twice at intervals of 12-102 months (mean, 39 months). The shunt index was higher for more severe disorders, increasing in the order of mild chronic hepatitis, moderate chronic hepatitis, severe chronic hepatitis, cirrhosis without varices, and cirrhosis with varices. The mean annual changes in the mean shunt index were 1.0% in mild chronic hepatitis, 4.4% in moderate chronic hepatitis, 6.1% in severe chronic hepatitis, 10.7% in cirrhosis without varices, and 6.2% in cirrhosis and varices. Cirrhotic patients were arbitrarily divided into two groups of roughly equal size on the basis of the shunt index at the first examination. In those with a shunt index of 30% or more, the mean annual change was 4.7%. The patients with a shunt index of less than 30% had a mean annual change of 11.8%. Changes in the portal hemodynamics were not steady. The shunt index rose gradually as disease advanced from mild to moderate and to severe chronic hepatitis and cirrhosis of the liver, after which the index rose rapidly when varices developed, slowing later.
经直肠门静脉闪烁显像术可相对无创地评估门静脉循环。我们采用该方法评估慢性肝病合并潜在肝病毒感染患者的门静脉血流动力学；这些患者无需手术或硬化治疗，或拒绝接受此类治疗，从而确定其自然病程的变化。将高锝[Tc-99m]酸盐溶液注入直肠，同时采集系列闪烁图，并生成肝脏和心脏的放射性曲线。根据这些曲线计算经直肠门静脉分流指数。在一项纵向研究中，70例患者（9例轻度慢性肝炎、10例中度慢性肝炎、7例重度慢性肝炎、22例肝硬化但无静脉曲张、22例肝硬化且有静脉曲张）至少接受了两次检查，间隔时间为12 - 102个月（平均39个月）。病情越严重，分流指数越高，其升高顺序为轻度慢性肝炎、中度慢性肝炎、重度慢性肝炎、无静脉曲张的肝硬化、有静脉曲张的肝硬化。轻度慢性肝炎患者平均分流指数的年均变化为1.0%，中度慢性肝炎为4.4%，重度慢性肝炎为6.1%，无静脉曲张的肝硬化为10.7%，有静脉曲张的肝硬化为6.2%。根据首次检查时的分流指数，将肝硬化患者任意分为两组，每组人数大致相等。分流指数为30%或更高的患者，年均变化为4.7%。分流指数低于30%的患者年均变化为11.8%。门静脉血流动力学变化并不稳定。随着疾病从轻度慢性肝炎进展至中度、重度慢性肝炎及肝硬化，分流指数逐渐上升，之后当出现静脉曲张时指数迅速上升，随后又减缓。
