Abstract
Many clinical and pathological studies have been carried out to elucidate the pathophysiology of liver cirrhosis. In this report, we investigated the correlation between serum total bile acid (TBA) and serum bilirubin, prothrombin activity and ICG-R 15 using 36 liver cirrhosis patients. The relationship between TBA and clinical signs, such as splenomegaly and esophageal varices was also studied. In several cases, shunt formation rate, which was obtained by per-rectal portal 99mTcO4-scintigraphy, was compared with TBA. High TBA values were found in more than 80% of the cirrhosis patients. In addition, in almost all cirrhosis cases, M-TBA's were markedly increased. High F-TBA value was found to be correlated to serum bilirubin and prothrombin activity, which are known as markers of liver cell function, with correlation coefficients of 0.664 and -0.515, respectively. In addition to the correlation between M-TBA and serum bilirubin, M-TBA also correlated very highly with prothrombin activity. It is well known that high ICG-R 15 values and clinical signs such as splenomegaly and varices are characteristic of progressed cirrhosis. When correlations between TBA and ICG-R15, splenomegaly and varices were examined, they were closely related to each other. When per-rectal portal scintigraphy was performed on several of our patients, in four cases in six (80%), 99mTcO4-appeared first in the heart-prior to the liver. In all cases which showed preferential appearance of Tc in the heart, both F-TBA and M-TBA were increased. Notably, in these cases, AUC values were drastically increased. These results indicated that increased TBA, including AUC, reflected the shunt formation rate rather than liver cell function in cirrhosis. It was also concluded that M-TBA is much more invaluable in following the progress of cirrhosis than is F-TBA.
