- 期刊
Endoscopic Measurement of Gastric Mucosal Blood Flow by Laser Doppler Flowmetry in Liver Cirrhotics and Non-Cirrhotics
經內視鏡雷射杜卜勒計測量肝硬化病人和非肝硬化病人胃黏膜血流
摘要
肝硬化病人較高的胃病變發生率是造成上消化道出血的重要原因，近年來胃黏膜微血流的異常被認為可能是主要的致病機轉之一。由於經內視鏡雷射杜卜勒計的應用，提供了一個方便的研究工具，我們藉此測量31位肝硬化病人和16位非肝硬化病人的胃黏膜血流，結果發現肝硬化病人的胃黏膜血流高於非肝硬化病人，具有統計學的意義。肝硬化病人合併有靜脈瘤者較未合併者高，在胃上、下體部皆具統計學的意義。肝功能狀態屬於Child C者較A和B者高，其中除了Child C比B在胃上體部以外，均呈有意義的差別。兩組病人均以胃竇部最低，胃下體部次之，胃上體部包括底部最高。肝硬化病人的胃病變，包括潰瘍、糜爛、胃炎和鬱血性胃病變的盛行率為90.3%，遠高於非肝硬化病人的31.2%。其中，鬱血性胃病變為32.2%，主要分佈於胃體部和底部。其胃黏膜血流低於無此病變者，在胃竇部及下體部皆有意義的差別。結論：肝硬化病人的胃黏膜血流高於非肝硬化病人，兩組在胃的各個不同的部位均具有部位性的差異。肝硬化病人的胃黏膜血流狀態，與靜脈瘤、肝功能狀態和鬱血性胃病變有關。
並列摘要
Gastric mucosal blood flow (MBF) in 31 liver cirrhotics and 16 non-cirrhotic controls was measured by endoscopic laser Doppler flowmetry. The MBF was significantly higher in cirrhotic patients than that in non-cirrhotic controls. In cirrhotic patients, gastric MBF was higher in patients with vat-ices than those without varices (with significant difference at both the lower body and high body), higher in patients with Child C liver status than those with Child A liver status (with significant difference in the whole stomach) and those with Child B liver status (with significant difference at both the antrum and lower body), and lower in patients with congestive gastropathy than those without congestive gastropathy (with significant difference at both the antrum and lower body). There was a trend of increasing gastric MBF from the antrum, through the lower body to the high body in both liver cir-rhotics and non-cirrhotics. The prevalence of gastric lesions by endoscopy was high (90.3% in cirrhotics vs 31.2% in non-cirrhotics). A prevalence of mosaic pattern of congestive gastropathy was revealed endoscopically, mainly at the fundus and body, as 32.2% (vs none in non-cirrhotics). It is concluded that the gastric MBF increases in cirrhotics with significant regional differences, compared with non-cirrhotic controls. The hemodynamic state in liver cirrhotics is related to the presence of varices, congestive gastropathy and the severity of liver disease.