Evaluation of Liver Functional Reserve by Clearance Rate of D-Sorbitol and Liver Volume Measurement with CT_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yiming , LI Hua , JI Hong , XU Xin

Department of General Surgery, the Second Affiliated Hospital, Medical School of Xi’an Jiaotong University, Xi’an 710004, ChinaCorresponding Author: LI Hua, E-mail: ongig@sina.com;

Corresponding author：

Keywords：

D-sorbitol; Liver volume; Hepatic functional blood flow; Cirrhosis; Hepatic functional reserve; CT

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Objective 　To evaluate hepatic functional reserve and investigate the clinical value through measuring hepatic functional blood flow by D-sorbitol clearance rate and liver volume changes with CT.
Methods 　Ninety-two patients with portal hypertension due to posthepatic cirrhosis were investigated (cirrhosis group). Twenty healthy volunteers were used as control group. D-sorbitol was infused intravenously at a steady rate. Blood and urine were collected and recorded once before infusion and at 120, 150 and 180 min after infusion, and their concentrations of D-sorbitol were examined by enzyme spectrophotometry. From pharmacokinetic equations, hepatic clearance rate of D-sorbitol (CLH) was calculated. Total hepatic blood flow (QTOTAL) was measured by Doppler sonography, intrahepatic shunt rate (RINS) was obtained. The liver volume change rate was obtained in patients with cirrhosis through the abdominal CT scan. The relations among the indicators, Child classification and postoperative complications were studied.
Results 　After D-sorbitol was infused intravenously for 120 min, the plasma concentration was at the steady state. The plasma concentration was (0.189±0.05) mmol/L in control group and (0.358±0.06) mmol/L in cirrhosis group (P lt;0.01). CLH was (1 248.3±210.5) ml/min in control group and (812.7±112.4) ml/min in cirrhosis group (P lt;0.01). Although QTOTAL in cirrhosis group was declined, compared with the control group 〔(1 280.6±131.4) ml/min vs. (1 362.4±126.9) ml/min〕, P gt;0.05, while RINS increased markedly 〔(36.54±10.65)% vs. (8.37±3.32)%, P lt;0.01〕. In cirrhosis group, the mean liver volume of Child A, B and C patients were (1 057±249) cm3, (851±148) cm3 and (663±77) cm3 respectively. There were significant differences among the mean liver volume (P lt;0.05). The liver volume was significantly smaller in Child B and C patients than that in Child A (P lt;0.05, P lt;0.01). When CLH was less than 600 ml/min, and liver volume decreased by more than 40%, postoperative complications increased significantly. CLH and the liver volume change rate were not in absolutely good accordance with Child classification.
Conclusion 　The hepatic clearance of D-sorbitol and the quantitative determination of the liver volume with CT can be an objective evaluation of the liver metabolism of the inherent capacity and the hepatic functional blood flow changes. It contributes to the correct understanding of the hepatic functional reserve and lay the foundation for determining a reasonable treatment plan, surgical methods and time.

Citation： LI Yiming,LI Hua,JI Hong,XU Xin. Evaluation of Liver Functional Reserve by Clearance Rate of D-Sorbitol and Liver Volume Measurement with CT. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(4): 285-289. doi: Copy

1.	Zoli M, Magalotti D, Bianchi G, et al. Total and functional hepatic blood flow decrease in parallel with ageing [Ｊ]. Age Ageing, 1999; 28(1): 29-33.
2.	Proctor E, Chatamra K. High yield micronodular cirrhosis in the rat [Ｊ]. Gastroenterology, 1982; 83(6): 1183-1190.
3.	Schiano TD, Bodian C, Schwartz ME, et al. Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation [Ｊ]. Transplantation, 2000; 69(4): 545-550.
4.	Rosemurgy AS 2nd, Norman JG, Goode SE. Does the direction of portal blood flow determine outcome with small-diameter prosthetic H-graft portacaval shunt? [Ｊ]. Surgery, 1997; 121(1): 95-101.
5.	Sugimoto H, Kaneko T, Inoue S, et al. Simultaneous Doppler measurement of portal venous peak velocity, hepatic arterial peak velocity, and splenic arterial pulsatility index for assessment of hepatic circulation [Ｊ]. Hepatogastroenterology, 2002; 49(45): 793-797.
6.	Keiding S, Engsted E, Ott P. Sorbitol as a test substance for measurement of liver plasma flow in humans [Ｊ]. Hepatology, 1998; 28(1): 50-56.
7.	Heymsfield SB, Rolandelli R, Casper K, et al. Application of electromagnetic and sound waves in nutritional assessment [Ｊ]. JPEN J Parenter Enteral Nutr, 1987; 11(5 Suppl): 64S-69S.
8.	Urata K, Hashikura Y, Ikegami T, et al. Standard liver volume in adults [Ｊ]. Transplant Proc, 2000; 32(7): 2093-2094.
9.	Zipprich A, Steudel N, Behrmann C, et al. Functional significance of hepatic arterial flow reserve in patients with cirrhosis [Ｊ]. Hepatology, 2003; 37(2): 385-392.
10.	Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection [Ｊ]. J Gastrointest Surg, 2003; 7(3): 325-330.
11.	Blker H, Theuer D, Otto HF. Pathology of liver cirrhosis and portal hypertension [Ｊ]. Radiologe, 2001; 41(10): 833-839.
12.	Pan Z, Wu XJ, Li JS, et al. Functional hepatic flow in patients with liver cirrhosis [Ｊ].World J Gastroenterol, 2004; 10(6): 915-918.
13.	Burggraaf J, Schoemaker RC, Lentjes EG, et al. Sorbitol as a marker for drug-induced decreases of variable duration in liver blood flow in healthy volunteers [Ｊ]. Eur J Pharm Sci, 2000; 12(2): 133-139.
14.	Molino G, Avagnina P, Belforte G, et al. Assessment of the hepatic circulation in humans: new concepts based on evidence derived from a D-sorbitol clearance method [Ｊ]. J Lab Clin Med, 1998; 131(5): 393-405.
15.	任贵兵, 钱崇宽, 赵端仪, 等. D-山梨醇清除率法补充吲哚氰绿潴留率和Child-Pugh分级评估肝储备功能 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(4): 271-273.
16.	Molino G, Avagnina P, Ballarè M, et al. Combined evaluation of total and functional liver plasma flows and intrahepatic shunting [Ｊ]. Dig Dis Sci, 1991; 36(9): 1189-1196.
17.	Koranda P, Myslivecek M, Erban J, et al. Hepatic perfusion changes in patients with cirrhosis indices of hepatic arterial blood flow [Ｊ]. Clin Nucl Med, 1999; 24(7): 507-510.
18.	Piscaglia F, Donati G, Serra C, et al. Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension [Ｊ]. Ultrasound Med Biol, 2001; 27(7): 893-899.
19.	Imsamran W, Leelawat K, Leelawat T, et al. Simple technique in the measurement of liver volume [Ｊ]. J Med Assoc Thai, 2003; 86(2): 151-156.
20.	Dunkelberg JC, Feranchak AP, Fitz JG. Liver cell volume regulation: size matters [Ｊ]. Hepatology, 2001; 33(6): 1349-1352.
21.	潘峥, 吴性江, 黎介寿, 等. 肝硬化门静脉高压症患者肝脏功能性血流量检测的临床意义 [Ｊ]. 中华普通外科杂志, 2004; 19(11): 653-655.
22.	王茂春, 冷希圣, 彭吉润, 等. 肝硬变门静脉高压症患者肝体积测量研究及其临床意义 [Ｊ]. 中国普外基础与临床杂志, 2003; 10(6): 586-592.
23.	Hoshida Y, Shiratori Y, Koike Y, et al. Hepatic volumetry to predict adverse events in percutaneous ablation of hepatocellular carcinoma [Ｊ]. Hepatogastroenterology, 2002; 49(44): 451-455.

1. Zoli M, Magalotti D, Bianchi G, et al. Total and functional hepatic blood flow decrease in parallel with ageing [Ｊ]. Age Ageing, 1999; 28(1): 29-33.
2. Proctor E, Chatamra K. High yield micronodular cirrhosis in the rat [Ｊ]. Gastroenterology, 1982; 83(6): 1183-1190.
3. Schiano TD, Bodian C, Schwartz ME, et al. Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation [Ｊ]. Transplantation, 2000; 69(4): 545-550.
4. Rosemurgy AS 2nd, Norman JG, Goode SE. Does the direction of portal blood flow determine outcome with small-diameter prosthetic H-graft portacaval shunt? [Ｊ]. Surgery, 1997; 121(1): 95-101.
5. Sugimoto H, Kaneko T, Inoue S, et al. Simultaneous Doppler measurement of portal venous peak velocity, hepatic arterial peak velocity, and splenic arterial pulsatility index for assessment of hepatic circulation [Ｊ]. Hepatogastroenterology, 2002; 49(45): 793-797.
6. Keiding S, Engsted E, Ott P. Sorbitol as a test substance for measurement of liver plasma flow in humans [Ｊ]. Hepatology, 1998; 28(1): 50-56.
7. Heymsfield SB, Rolandelli R, Casper K, et al. Application of electromagnetic and sound waves in nutritional assessment [Ｊ]. JPEN J Parenter Enteral Nutr, 1987; 11(5 Suppl): 64S-69S.
8. Urata K, Hashikura Y, Ikegami T, et al. Standard liver volume in adults [Ｊ]. Transplant Proc, 2000; 32(7): 2093-2094.
9. Zipprich A, Steudel N, Behrmann C, et al. Functional significance of hepatic arterial flow reserve in patients with cirrhosis [Ｊ]. Hepatology, 2003; 37(2): 385-392.
10. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection [Ｊ]. J Gastrointest Surg, 2003; 7(3): 325-330.
11. Blker H, Theuer D, Otto HF. Pathology of liver cirrhosis and portal hypertension [Ｊ]. Radiologe, 2001; 41(10): 833-839.
12. Pan Z, Wu XJ, Li JS, et al. Functional hepatic flow in patients with liver cirrhosis [Ｊ].World J Gastroenterol, 2004; 10(6): 915-918.
13. Burggraaf J, Schoemaker RC, Lentjes EG, et al. Sorbitol as a marker for drug-induced decreases of variable duration in liver blood flow in healthy volunteers [Ｊ]. Eur J Pharm Sci, 2000; 12(2): 133-139.
14. Molino G, Avagnina P, Belforte G, et al. Assessment of the hepatic circulation in humans: new concepts based on evidence derived from a D-sorbitol clearance method [Ｊ]. J Lab Clin Med, 1998; 131(5): 393-405.
15. 任贵兵, 钱崇宽, 赵端仪, 等. D-山梨醇清除率法补充吲哚氰绿潴留率和Child-Pugh分级评估肝储备功能 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(4): 271-273.
16. Molino G, Avagnina P, Ballarè M, et al. Combined evaluation of total and functional liver plasma flows and intrahepatic shunting [Ｊ]. Dig Dis Sci, 1991; 36(9): 1189-1196.
17. Koranda P, Myslivecek M, Erban J, et al. Hepatic perfusion changes in patients with cirrhosis indices of hepatic arterial blood flow [Ｊ]. Clin Nucl Med, 1999; 24(7): 507-510.
18. Piscaglia F, Donati G, Serra C, et al. Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension [Ｊ]. Ultrasound Med Biol, 2001; 27(7): 893-899.
19. Imsamran W, Leelawat K, Leelawat T, et al. Simple technique in the measurement of liver volume [Ｊ]. J Med Assoc Thai, 2003; 86(2): 151-156.
20. Dunkelberg JC, Feranchak AP, Fitz JG. Liver cell volume regulation: size matters [Ｊ]. Hepatology, 2001; 33(6): 1349-1352.
21. 潘峥, 吴性江, 黎介寿, 等. 肝硬化门静脉高压症患者肝脏功能性血流量检测的临床意义 [Ｊ]. 中华普通外科杂志, 2004; 19(11): 653-655.
22. 王茂春, 冷希圣, 彭吉润, 等. 肝硬变门静脉高压症患者肝体积测量研究及其临床意义 [Ｊ]. 中国普外基础与临床杂志, 2003; 10(6): 586-592.
23. Hoshida Y, Shiratori Y, Koike Y, et al. Hepatic volumetry to predict adverse events in percutaneous ablation of hepatocellular carcinoma [Ｊ]. Hepatogastroenterology, 2002; 49(44): 451-455.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Evaluation of Liver Functional Reserve by Clearance Rate of D-Sorbitol and Liver Volume Measurement with CT

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