Abstract
Since the peripheral circulation in chronic liver diseases was almost unknown, peripheral hemodynamics were studied in 23 patients with chronic hepatitis (CH), 41 with liver cirrhosis (LC) and in 33 healthy subjects (HS) by means of venous occlusion pneumoplethysmography (Winsor Vasograph, EMI Co.).
Forearm blood flow (FBF) of the patients with CH (2.58±1.18 ml/dl/min) and with LC (3.01±1.30) were significantly higher than that of HS (1.75±0.69). Concerning calf blood flow (CBF) of the 3 groups, however, no significant difference was found among them.
In those with CH and LC, FBF were significantly higher than CBF, although in HS no difference was noted between them. Forearm vascular resistance (FVR) of those with CH (41.5±20.5 mmHg/ml/dl/min) and with LC (33.6±13.2) were lower than that of HS (60.0±27.3). On the contrary, there was no difference in calf vascular resistance (CVR) among the 3 groups. FVR was lower than CVR in those with chronic liver disease, while no difference was noticed in HS.
Furthermore, deep body temperature (DBT), another index of blood flow, was measured at forearm and calf with Coretemp (CTM 201). FDBT was significantly higher than CDBT in those with LC and CH, but no difference was found in HS. These results showed the evidence of heterogeneity of peripheral circulation in chronic liver disease.
To evaluate. the pathogenesis of the heterogeneity, the cirrhotic patients were divided into two groups according to the severity of heterogeneity: Group A, 15 patients in which FBF-CBF score was more than 1 ml/dl/min, Group B, 26 patients with the score less than 1 ml/dl/min. There was no significant difference between the two groups concerning frequency of vascular spider and palmar erythema, levels of cardiac index, total peripheral resistance and wedged hepatic venous pressure, respectively. When the reactivity of vasculature to stimulus (cold pressor test) was examined, FVR and CVR increased significantly in Group B and healthy subjects, while in Group A FVR did not respond to the stimulus. There was no significant difference in arteriovenous oxygen difference between Group A and B.
From these results, it is concluded that chronic liver diseases had heterogeneity of peripheral circulation, which was partly due to impaired autonomic reflex of the vasculature.
