Journal Article 飲酒がC型肝硬変患者の肝血流に与える影響

和久井, 紀貴  ,  荻野, 悠  ,  松井, 哲平  ,  小林, 康次郎  ,  松清, 靖  ,  丸山, 憲一  ,  住野, 泰清

63 ( 2 )  , pp.106 - 112 , 2016-6 , 東邦大学医学会
目的: 飲酒がC型肝硬変(hepatitis C virus-related liver cirrhosis:CLC)の肝血流にどのような影響を与えるかperfusion parametric imaging(P-PI)を用いて明らかにする.対象と方法: 対象は約2年の間で造影超音波検査(contrast-enhanced ultrasonography:CEUS)を施行したCLC 31例.推奨量のSonazoid★(GE Healthcare, Oslo, Norway)を静注し,右肋間走査から肝実質染影開始~門脈が描出されるまでを赤色,門脈が描出された後を黄色に色分けするような設定でP-PIを作成した.得られた画像から動脈化率(arterial ratio:AR)を算出.その後,飲酒なし群のChild-Pugh(CP)分類別のARを多重比較した.またCP分類別に飲酒なし群とあり群のARを比較した.結果: 全症例のCPはA:4例,B:22例,C:5例であった.飲酒なし群におけるCP分類別のARの中央値はA:51.4%,B:52.9%,C:81.7%であり,BとCに有意差を認めた(p=0.0043).B症例の中でエタノール換算125 g以上の飲酒あり群となし群のARを比較した結果,有意な差を認めた(p=0.037).結論: 飲酒,特に大酒はCLCの肝血流に影響を与え,動脈優位化の規定因子の1つになる可能性が示唆された.Background: Perfusion parametric imaging was used to determine the effects of alcohol intake on hepatic blood flow in patients with type C liver cirrhosis. Methods: During a 2-year period, 31 patients with hepatitis C virus-related liver cirrhosis (CLC) were examined by contrast-enhanced ultrasonography. After intravenous injection of the recommended amount of Sonazoid★, perfusion parametric images of liver parenchyma from the right intercostal space were obtained in order to display hepatic blood flow before and after enhancement of the portal vein, using red and yellow pixels, respectively. These images were then used to measure arteria ratio (AR). Multiple intra- and intergroup analyses of AR values in relation to Child-Pugh (CP) class compared patients who drank alcohol with those who did not. Results: In the analysis of CP class, 4 patients were CP class A (CP-A), 22 were CP-B, and 5 were CP-C. Among nondrinkers, the median AR values were 51.4%, 52.9%, and 81.7% in CP-A, CP-B, and CP-C patients, respectively. The values for the CP-B and CP-C subgroups significantly differed (p=0.0043). In addition, AP values significantly differed between CP-B patients who consumed 125 g or more ethanol and those who did not (p=0.037). Conclusions: Alcohol consumption, especially when heavy, adversely affects hepatic blood flow in patients with CLC and is an indicator of AR.

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