肝硬度が血管形成術治療効果判定に有用であったBudd-Chiari症候群の1例  [in Japanese] Liver stiffness is a useful marker for assessing the therapeutic effect of angioplasty in Budd-Chiari syndrome: A case report  [in Japanese]

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Author(s)

    • 永原 蘭 Nagahara Ran
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 大山 賢治 Ohyama Kenji
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 岡野 淳一 Okano Junichi
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 磯本 一 Isomoto Hajime
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 小谷 美香 Kodani Mika
    • 鳥取大学医学部附属病院放射線科 Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University
    • 矢田 晋作 Yata Shinsaku
    • 鳥取大学医学部附属病院放射線科 Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University
    • 大内 泰文 Ohuchi Yasufumi
    • 鳥取大学医学部附属病院放射線科 Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University
    • 的野 智光 Matono Tomomitsu
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 孝田 雅彦 Koda Masahiko
    • 鳥取大学医学部附属病院消化器内科|日野病院組合日野病院 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University|Department of Internal Medicine, Hino Hospital
    • 松木 由佳子 Matsuki Yukako
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 山根 昌史 Yamane Masashi
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 岡本 敏明 Okamoto Toshiaki
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 三好 謙一 Miyoshi Kenichi
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 永原 天和 Nagahara Takakazu
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University
    • 杉原 誉明 Sugihara Takaaki
    • 鳥取大学医学部附属病院消化器内科 Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University

Abstract

<p>症例32歳女性.右肝静脈,中肝静脈の完全閉塞,左肝静脈に強い狭窄をきたしたBudd-Chiari症候群に対して経皮的血管形成術を行った.治療前後で静脈瘤,血小板数の改善を認め,これに平行してFibroScanを用いて測定した肝硬度値は前値66.4 kPaから治療直後16.8 kPa,4カ月後10.4 kPaと顕著な低下を認めた.また,血清ヒアルロン酸も治療前76 ng/m<i>l</i>から治療4カ月後9 ng/m<i>l</i>以下へ低下した.肝硬度値やヒアルロン酸は肝うっ血により上昇することが報告されている.本例のように肝硬度やヒアルロン酸は治療によって肝うっ血所見の改善とともに低下したことから,Budd-Chiari症候群に対する血管形成術の短期治療効果を反映することが示唆された.</p>

<p>A 32-year-old Japanese woman was diagnosed with Budd-Chiari syndrome with complete obstruction of the right and the middle hepatic vein as well as severe stenosis in the left hepatic vein. She had esophageal varices (F2) and low platelet counts (10.7 × 10<sup>4</sup>/mm<sup>3</sup>). She underwent percutaneous transluminal angioplasty (PTA) for the left hepatic vein. Liver stiffness was decreased from 66.4 kPa before PTA to 16.8 kPa after 3 h and 10.4 kPa after 4 months with an improvement in the esophageal varices (F0) and platelet count (16.5 × 10<sup>4</sup>/mm<sup>3</sup>). Furthermore, the serum level of hyaluronic acid decreased from 76 ng/m<i>l</i> before PTA to <9 ng/m<i>l</i> after 4 months. To our knowledge, this is the first case wherein liver stiffness was able to reflect hepatic congestion and helped monitor the therapeutic effect in Budd-Chiari syndrome.</p>

Journal

  • Kanzo

    Kanzo 59(10), 563-570, 2018

    The Japan Society of Hepatology

Codes

  • NII Article ID (NAID)
    130007500606
  • NII NACSIS-CAT ID (NCID)
    AN00047770
  • Text Lang
    JPN
  • ISSN
    0451-4203
  • NDL Article ID
    029290461
  • NDL Call No.
    Z19-130
  • Data Source
    NDL  J-STAGE 
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