急性重症酒精性肝炎肝动脉缓冲效应研究进展*

目的 急性重症酒精性肝炎患者肝窦存在致密胶原沉积,阻力增加阻碍了血液流经肝窦,窦性压力增加,门静脉血流不畅,门静脉向肝窦的灌注显著减少,此时就启动了肝动脉缓冲效应,后者可以抵消肝脏灌注的两个主要血管肝动脉或门静脉中任何一个的流量减少,维持肝脏总血流量在一个生理范围内,使肝脏灌注(肝动脉和门静脉血流之和)恢复正常。双功能多普勒超声可以无创评估肝脏血流动力学和定量肝动脉缓冲效应。因此,肝动脉缓冲效应可能成为诊断急性重症酒精性肝炎的重要检测方法之一。

Hepatic artery buffering response in patients with severe acute alcoholic hepatitis

Objective There is a dense collagen deposition in hepatic sinusoide in patients with severe acute alcoholic hepatitis (SAAH), which increase the sinusoidal resistance with increased pressure and block blood flow through hepatic sinusoids. The portal vein blood flow is compromised in a retrograde manner with obviously reduced portal venous perfusion. Consequently, the hepatic artery buffering response (HABR) is triggered to counteract the decreased blood flow from hepatic artery or portal vein to maintain a physiological requirement and restore the hepatic perfusion, e.g., the sum of hepatic artery and portal vein blood flow. The hepatic hemodynamics and quantitative HABR can be assessed by Duplex Doppler ultrasonography, and the latter could be a noninvasive approach for the diagnosis of SAAH.