肝循環動態に関する研究

第1編 肝疾患における肝循環動態とBSP試験の関係

抄録

The volume of hepatic blood flow was determined on a total of 100 hepatic diseass patients; acute hepatitis 2, chronic hepatitis 75, hepatocirrhosis 21 and fatty liver 2; by Galactose continual Infusion Method devised by Nakamura et al. At the same time, the correlation between state of hepatic circulation and BSP test was observed stochastically using as index the BSP test findings noted at time of initial out-patient examination and the BSP test find ings obtained within one week both prior to and after hepatic blood flow volume determination made following admission to the hospital. Further, comparisons were made with the hepatic tissue picture obtained by biopsy. The followresults were obtained.
1) The average value of the total hepatic blood flow Volume for the 100 hepatic disease cases was 857±46 cc/min/M². The 49 cases with wedded hepatic venous pressure (WHVP), but without hepatic shunt flow had an average value of 135±21 mm H₂O.
2) A positive correlation with a coefficient of 0.69 was noted between WHVP and BSP test results. Further, an approximate value of 0.64 was demonstrated between the initial out-patient BSP test findings. In cases with WHVP of over 175mm H₂O, the change-over rate to negative BSP test results following 3 to 4 weeks of hospitalization, bedrest and treatment was 13.8%, and 71.1% for those with values of less than 175mm H₂O.
3) A negative correlation with a coefficient of -0.34 was noted between effective hepatic blood flow volume and BSP test results. Further, a negative correlation of -0.27 was demonstrated between the initial out-patient BSP test findings. In cases with an effective hepatic blood flow volume of less than 500 cc/min/M², the change-over rate to negative BSP test results following 3 to 4 weeks of hospitalization, bedrest and treatment was 35.0%, while that of cases with volumes of over 500 cc/min/M² was 48.9%.
4) A positive correlation with a coefficient of 0.55 was noted between rate of hepatic short circuit and BSP test results. A positive correlation of 0.50 was demonstrated between the initial outpatient BSP test findings. In cases with hepatic short circuit, the change-over rate to negative BSP test results following 3 to 4 weeks of hospitalization, bedrest and treatment was 1%, while that in those without hepatic short circuit was 63.3%.
5) Of the 42 cases with more than a moderate degree of hepatic cell degeneration and necrosis (includes 2 cases with negative BSP test findings from the beginning), 9 cases or 22.5% demonstrated normal BSP test findings following 3 to 4 weeks of hospitalization, bedrest and treatment, while of 58 cases with slight degeneration and necrosis (includes 2 cases with normal BSP test findings from the beginning), 24 cases or 82.8% became normal during the same short period of time.
6) A follow-up BSP test survey wase conducted on 30 chronic hepatitis cases whose BSP test findings at time of discharge had become normal, and aggravations were noted in 11. Among those with aggravations, 7 or 63.5% had hepatic circulatory abnormalities during hospitalization.
7) From the above findings, it has been shown that not only degeneration and necrosis of hepatic cells are related to the BSP test value, but a relationship is also noted between the state of hepatic circulation. Therefore, it is necessary to consider both together before making any decision.