Colli A, Cocciolo M, Mumoli N, Cattalini N, Fraquelli M, Conte D
Divisione di Medicina, Ospedale Civile, Morbegno, Sondrio, Italy.
Hepatology. 1998 Nov;28(5):1182-6. doi: 10.1002/hep.510280503.
Patency and direction of flow in portal veins and their branches are generally assessed by duplex Doppler ultrasonography (DDUS), whereas few data are available on hepatic arterial hemodynamics. In this study, resistive (RI) and pulsatility indexes (PI) were calculated at DDUS in 21 controls, 22 chronic alcoholic patients without evidence of liver damage, 19 patients with acute alcoholic hepatitis (AAH), 30 patients with chronic viral hepatitis (CVH), 23 patients with alcoholic cirrhosis, and 22 patients with viral-related cirrhosis. Diagnosis was based on clinical and histological findings. Mean +/- SD RI was similar in controls and CVH patients (0.64 +/- 0. 02 and 0.66 +/- 0.04, respectively), significantly decreased in alcoholic patients without liver damage and AAH patients (0.61 +/- 0. 07 and 0.60 +/- 0.07) (P < .05), and significantly increased in patients with alcoholic (0.72 +/- 0.04) and viral-related cirrhosis (0.74 +/- 0.04) (P < .05). It was <0.60 in 9 of the 19 AAH patients (47%) and 11 of the 22 alcoholic patients without liver damage (50%), and >0.70 in 39 of the 45 cirrhotic patients (87%) and 12 of the 71 noncirrhotic patients pooled together (17%). A significant correlation was observed between RI and PI (r = .83; P < .05). The coefficients of variation for intraobserver variability were 6.3% +/- 5.1% for RI and 10.1% +/- 6.2% for PI, and the corresponding figures for interobserver variability were 5.2% +/- 3.5% and 9.3% +/- 4.6%. These findings support the existence of ethanol-related hepatic arterial vasodilation in AAH and alcoholic patients without liver damage. Progression of liver damage from AAH to cirrhosis profoundly impairs the hepatic responsiveness as a consequence of fibrosis with vascular distortion.
门静脉及其分支的通畅性和血流方向一般通过双功多普勒超声检查（DDUS）来评估，而关于肝动脉血流动力学的数据则很少。在本研究中，计算了21名对照组、22名无肝损伤证据的慢性酒精性患者、19名急性酒精性肝炎（AAH）患者、30名慢性病毒性肝炎（CVH）患者、23名酒精性肝硬化患者和22名病毒相关性肝硬化患者在DDUS检查时的阻力指数（RI）和搏动指数（PI）。诊断基于临床和组织学检查结果。对照组和CVH患者的平均±标准差RI相似（分别为0.64±0.02和0.66±0.04），无肝损伤的酒精性患者和AAH患者的RI显著降低（分别为0.61±0.07和0.60±0.07）（P<0.05），酒精性（0.72±0.04）和病毒相关性肝硬化患者的RI显著升高（0.74±0.04）（P<0.05）。19名AAH患者中有9名（47%）和22名无肝损伤的酒精性患者中有11名（50%）的RI<0.60，45名肝硬化患者中有39名（87%）和71名非肝硬化患者汇总后的12名（17%）的RI>0.70。RI和PI之间存在显著相关性（r = 0.83；P<0.05）。观察者内变异系数对于RI为6.3%±5.1%，对于PI为1%±6.2%，观察者间变异系数的相应数值为5.2%±3.5%和9.3%±4.6%。这些发现支持在AAH和无肝损伤的酒精性患者中存在与乙醇相关的肝动脉血管舒张。由于伴有血管扭曲的纤维化，肝损伤从AAH进展为肝硬化会严重损害肝脏反应性。
