Sugano S, Nishio M, Makino H, Suzuki T
Department of Internal Medicine, Saiseikai Wakakusa Hospital, Yokohama, Japan.
Dig Dis Sci. 1999 Jan;44(1):149-54. doi: 10.1023/a:1026670604551.
We studied the relationship between portal pressure and colorectal mucosal vascular lesions in cirrhotics and the effectiveness of drug therapy in treating these lesions. Colonoscopy and hepatic venous pressure gradient (HVPG) studies were performed in 21 cirrhotics. Oral spironolactone plus transdermal nitroglycerin were given to patients who had diffuse mucosal cherry-red spots and/or rectal varices. The colonoscopy and HVPG determinations were repeated after four weeks. Colonoscopic findings included vascular ectasias in 13 patients (62%), diffuse cherry-red spots in the rectum in five patients (24%), and rectal varices in eight patients (38%). Overall, colorectal mucosal vascular lesions were found in 16 cirrhotics (76%). These findings were not found in 21 age- and sex-matched noncirrhotic controls. Vascular ectasias appeared without relationship to the HVPG. Patients with diffuse cherry-red spots (N = 5, 22.4+/-3.4 mm Hg) had a significantly higher HVPG than those without (N = 16, 16.6+/-3.3 mm Hg, P < 0.01). However, no significant difference was found in HVPG between patients with rectal varices (N = 8, 19.4+/-4.6 mm Hg) and patients without rectal varices (N = 13, 17.2+/-3.8 mm Hg). After four weeks of drug therapy, diffuse cherry-red spots became less obvious when the HVPG decreased more than 20%. Rectal varices did not change their appearance with HVPG reduction. We found that colorectal vascular lesions are common in cirrhotics. Diffuse cherry-red spots are probably dependent on elevated portal pressure, but vascular ectasias and rectal varices are not related to the degree of portal pressure. Chronic drug therapy with reduction of portal pressure improves colonoscopic findings such as diffuse cherry-red spots.
我们研究了肝硬化患者门静脉压力与结直肠黏膜血管病变之间的关系以及药物治疗这些病变的有效性。对21例肝硬化患者进行了结肠镜检查和肝静脉压力梯度（HVPG）研究。对有弥漫性黏膜樱桃红点和/或直肠静脉曲张的患者给予口服螺内酯加经皮硝酸甘油治疗。四周后重复进行结肠镜检查和HVPG测定。结肠镜检查结果包括13例患者（62%）有血管扩张，5例患者（24%）直肠有弥漫性樱桃红点，8例患者（38%）有直肠静脉曲张。总体而言，16例肝硬化患者（76%）发现有结直肠黏膜血管病变。在21例年龄和性别匹配的非肝硬化对照者中未发现这些表现。血管扩张的出现与HVPG无关。有弥漫性樱桃红点的患者（N = 5，22.4±3.4 mmHg）的HVPG显著高于无弥漫性樱桃红点的患者（N = 16，16.6±3.3 mmHg，P < 0.01）。然而，有直肠静脉曲张的患者（N = 8，19.4±4.6 mmHg）与无直肠静脉曲张的患者（N = 13，17.2±3.8 mmHg）之间的HVPG未发现显著差异。药物治疗四周后，当HVPG下降超过20%时，弥漫性樱桃红点变得不那么明显。直肠静脉曲张的外观不会随HVPG降低而改变。我们发现结直肠血管病变在肝硬化患者中很常见。弥漫性樱桃红点可能与门静脉压力升高有关，但血管扩张和直肠静脉曲张与门静脉压力程度无关。降低门静脉压力的慢性药物治疗可改善结肠镜检查结果，如弥漫性樱桃红点。
