アルコール性肝硬変における内視鏡的食道静脈瘤硬化療法前後の血行動態の変化―C型肝硬変との比較―  [in Japanese] Hepatic blood flows in patients with cirrhosis due to alcohol consumption before and after endoscopic injection sclerotherapy for esophagogastric varices: Comparison with those in cirrhotic patients caused by hepatitis C virus infection  [in Japanese]

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Author(s)

    • 重福 隆太 Shigefuku Ryuta
    • 聖マリアンナ医科大学消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
    • 伊東 文生 Itoh Fumio
    • 聖マリアンナ医科大学消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
    • 鈴木 通博 Suzuki Michihiro
    • 川崎市立多摩病院消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital
    • 高橋 秀明 Takahashi Hideaki
    • 聖マリアンナ医科大学横浜市西部病院消化器内科 Division of Gastroenterology, St. Marianna University School of Medicine Yokohama-City Seibu Hospital
    • 中野 弘康 Nakano Hiroyasu
    • 聖マリアンナ医科大学消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
    • 服部 伸洋 Hattori Nobuhiro
    • 聖マリアンナ医科大学消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
    • 池田 裕喜 Ikeda Hiroki
    • 聖マリアンナ医科大学消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
    • 渡邊 綱正 Watanabe Tsunamasa
    • 聖マリアンナ医科大学消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
    • 松永 光太郎 Matsunaga Kotaro
    • 聖マリアンナ医科大学消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
    • 松本 伸行 Matsumoto Nobuyuki
    • 聖マリアンナ医科大学消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine
    • 奥瀬 千晃 Okuse Chiaki
    • 川崎市立多摩病院消化器肝臓内科 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital

Abstract

<p>【背景】門脈圧亢進症では背景肝疾患の病因が重要で,病態により治療効果や再発率に影響すると考えられる.しかしアルコール性肝硬変(AL-LC)とC型肝硬変(C-LC)における血行動態の相違は明らかではない.【目的】AL-LC,C-LCにおいてXenon CT(Xe-CT)を用い食道静脈瘤に対する内視鏡的硬化療法(endoscopic injection sclerotherapy;EIS)前後の肝血流量を比較し血行動態の違いを明らかにする.</p><p>【方法】対象はAL-LC 18例(男17例),C-LC 19例(男10例).Xe-CTは,既報(Med Phys. 2008;35:2331)のごとく,治療前と治療1週後で門脈,肝動脈組織血流量(PVTBF,HATBF;ml/100 ml/min)を測定し,さらにPVTBF/HATBF(P/A)ratioを算出しAL-LCとC-LCの両者を治療前後で比較した.【結果】AL-LCの治療前/後の肝血流量は,PVTBF 25.6±6.3/29.8±6.2(<i>p</i>=0.006),HATBF 21.0±10.1/19.5±5.6,P/A ratio 1.4±0.7/1.7±0.7,C-LCの治療前/後の肝血流量は,PVTBF 28.9±9.4/29.2±8.2(NS),HATBF 24.1±16.1/18.5±8.2,P/A ratio 1.6±0.8/1.8±0.9.AL-LC群で再発率が高い傾向であった(<i>p</i>=0.08).【考察】AL-LCは入院後断酒しEISで側副血行路を閉鎖することでPVTBFが増加する可能性が推察された.しかしAL-LCは短期再発し,退院後の断酒継続ができていないことが主要因と考えられた.</p><p>【結論】C-LCとは異なり,AL-LCでは断酒によりEISで増加した門脈血流を受容しやすくなり,EIS後に門脈血流が増加した可能性が示唆された.</p>

<p><i>Aim:</i> Hemodynamic changes in hepatic blood flow after endoscopic injection sclerotherapy (EIS) compared to the baseline blood flow are to be elucidated in patients with cirrhosis both due to alcohol consumption and hepatitis C virus (HCV) infection. Thus, hepatic arterial tissue blood flow (HATBF) and portal venous tissue blood flow (PVTBF) were evaluated by xenon computed tomography (Xe-CT) in patients with cirrhosis receiving EIS for esophagogastric varices (EGV).</p><p><i>Methods:</i> Subjects were 18 patients with alcoholic cirrhosis and 19 patients with of HCV-related cirrhosis receiving EIS for EGV. Xe-CT was performed before and after EIS procedures. Total hepatic TBF (THTBF), splenic blood flow and PVTBF/HATBF (P/A) ratio were calculated.</p><p><i>Results:</i> PVTBF (ml/100 ml/min; mean±SD) before and after EIS procedures were 25.6±6.3 and 29.8±6.2, respectively, in patients with alcoholic cirrhosis, and 28.9±9.4 and 29.2±8.7, respectively, in patients with HCV-related cirrhosis; the values were increased significantly in the former patients (<i>p</i>=0.006), while were not altered in the latter patients. In contrast, HATBF, THTBF and P/A ratios were not changed after EIS procedures compared to baseline values.</p><p><i>Conclusions:</i> Portal venous flows were increased especially in patients with alcoholic cirrhosis after EIS procedures compared to those at baseline, and abstinence after admission might contribute to such hemodynamic changes.</p>

Journal

  • Japanese Journal of Portal Hypertension

    Japanese Journal of Portal Hypertension 23(1), 22-32, 2017

    The Japan Society for Portal Hypertension

Codes

  • NII Article ID (NAID)
    130007784447
  • NII NACSIS-CAT ID (NCID)
    AA11349565
  • Text Lang
    JPN
  • ISSN
    1344-8447
  • NDL Article ID
    028069278
  • NDL Call No.
    Z19-B965
  • Data Source
    NDL  J-STAGE 
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