丹参对门脉高压血流动力学影响的实验与临床研究

为研究丹参对肝硬化门脉血流动力学的影响，利用血管插管测定用药前后胆管结扎肝硬化犬门脉系统压力变化，超声多普勒监测肝硬化患者用药后门静脉系统血流动力的改变。结果：（１）丹参静脉给药可使肝硬化犬门静脉压（ＰＰＶ）、嵌塞肝静脉压（ＷＨＶＰ）、肝静脉压力梯度（ＨＶＰＧ）显著降低（Ｐ＜０．０５～０．０１），而平均动脉压（ＭＡＰ）、心率（ＨＲ）无明显变化（Ｐ＞０．０５）；（２）丹参长期口服（１０～１２周），可显著降低肝硬化患者（Ｃｈｉｌｄ－ＰｕｇｈＡ、Ｂ级）门静脉内径（ＤＰＶ）、脾静脉内径（ＤＳＶ）、门静脉血流量（ＱＰＶ）、脾静脉血流量（ＱＳＶ）（Ｐ＜０．０５～０．０１），并对患者乏力、厌食、腹胀及肝功能（ＡＬＴ）具有部分改善作用，未见副作用。本研究表明，丹参为安全有效的降低门静脉压力药物，值得对其做进一步研究。     

肝内型门静脉高压症大鼠内脏高动力循环状态

应用同位素标记的微球测定血流量和门－体分流的技术，检测ＣＣ１４肝硬化大鼠所致内脏和全身血液动力学变化。全部肝硬变大鼠都出现门静脉高压症（门静脉压力１．６５７±０．０６６，对照组１．２２３±０．０３６ｋＰａ；Ｐ＜０．００１）；门－体分流明显增高，但变异大（３５％±２５％，对照组０．３４±０．１６％；Ｐ＜０．０５），范围在３％～８２％间；门静脉血流量增加（７．３３±１．３，对照组６．２８±０．１８ｍＩ。ｍｉｎ－１·１００ｇＢＷ－１；Ｐ＜０．０５）；内脏血管阻力下降（０．６１±０．１４，对照组０．９±０．１９ｋＰａ·ｍ１－１·ｍｉｎ－１；Ｐ＜０．０１）；门静脉阻力未见明显增高（０．０７８±０．０１，对照１ｌｌ０．０７３±０．Ｏ０７ｋＰａ·ｍ１－１·ｍｉｎ－１；Ｐ＞０．０５）．肝硬变大鼠内脏血液动力学变化表明，门静脉高压症的维持，至少部分取决于高动力的门静脉循环，提供了肝内型门静脉高压症内脏循环高动力状态、门静脉血流量增加的定量资料。     

肝炎后肝硬变肝损害与细胞免疫功能(英文)

目的研究肝炎后肝硬变（ＰＨＣ）患者的细胞免疫状态及其与肝功能损害的关系．方法５１例ＰＨＣ患者，包括ＣｈｉｌｄＰｕｐｈＡ级２０例、Ｂ例１８例、Ｃ级１３例和２２例健康对照者，外周血经用ＦｉｃｏｌＨｙｐａｑｕｅ梯度离心分离单个核细胞后，采用３ＨＴｄＲ掺入技术测定了淋巴细胞转化，ＩＬ２和ＮＫ细胞活性．结果在ＰＨＣ患者淋巴细胞转化指数（ＳＩ）、ＩＬ２活性（ＳＩ）和ＮＫ细胞活性（％）较对照组均明显降低（１８１±１３０ＶＳ３４９±２１７，Ｐ＜００１；８１±６０ＶＳ１３６±５８，Ｐ＜００１；４０３±２１７ＶＳ６１３±２０５，Ｐ＜００１）．免疫功能缺陷与ＣｈｉｌｄＰｕｐｈ分级有关，Ｃ级明显低于Ａ、Ｂ级（Ｐ＜００１），Ｂ级低于Ａ级（Ｐ＜００５）．结论ＰＨＣ患者存在细胞免疫功能缺陷，且与肝损害程度有关．     

彩色多普勒在经颈静脉肝内门体分流术治疗肝硬化门静脉高压症患者中的应用

采用彩色多普勒超声显象仪在经颈静脉肝内门体分流术（ＴＩＰＳ）治疗８例肝硬化门静脉高压（ＣＰＨ）食管静脉曲张出血患者治疗前后测定患者门静脉血液动力学改变。方法采色多普勒超声显象仪测定ＴＩＰＳ术前以及术后一、三周门静脉血流速度们静脉血流量。结果术前门静脉血流速度、门静脉血流量为１０．２６±４．２５ｃｍ／ｓ、１１４５．３６±４３６．５２ｍｌ／ｍｉｎ,术后一、三周增高至２１．７０±５８９ｃｍ．ｓ、１９．７２±５．２４ｃｍ／ｓ和２２３８．７９±９７１．４ｍｌ／ｍｉｎ、２０５４．７１±８８０．５６ｍｌ／ｍｉｎ,Ｐ＜０．０１、０．０５。门静脉压力由３．６±０．７ｋＰａ降至１．７３±０．３５ｋＰａ,Ｐ＜０．０１。结论肝硬化门静脉高压症患者ＴＩＰＳ术前及术后进行彩色多普勒门静脉显象测定,可以了解门静脉血流状态、血管走行、有无血栓,对适应症的选择和判断预后有一定价值。     

肝硬化大鼠内脏血管壁NOS分布的免疫组化研究

目的：观察肝硬化门静脉高压大鼠内脏动、静脉血管壁一氧化氮合酶（ＮＯＳ）的分布及染色强度变化，探讨ＮＯ在门静脉高压形成机制中的作用。方法：采用免疫组化染色法，应用两种ＮＯＳ特异性抗体，分别观察内皮型（ｅＮＯＳ）和诱生型（ｉＮＯＳ）ＮＯＳ的变化特点，并结合计算机图象分析系统对染色强度进行量化处理。结果：肝硬化大鼠肠系膜上动脉（ＳＭＡ）ｉＮＯＳ和ｅＮＯＳ染色强度与对照组相比均显著增加（Ｐ＜０．０１），其中以ｅＮＯＳ增加更为明显。而两组门静脉（ＰＶ）ＮＯＳ染色强度则无明显差异（Ｐ＞０．０５）。肝硬化组ＳＭＡ的ＮＯＳ染色强度明显高于ＰＶ（Ｐ＜０．０５）。结论：ＮＯＳ在内脏血管表达增多，以及在ＳＭＡ的表达高于ＰＶ，提示ＮＯ可能主要通过扩张内脏动脉、增加内脏血流量而参与门静脉高压的形成。     

肝硬化患者门静脉系统血流动力学研究的临床价值

我们通过多普勒超声技术,探讨肝硬化患者门静脉系统血流动力学状态及其与Ｃｈｉｌｄ－Ｐｕｇｈ肝功能分级的关系,分析门静脉高压症的形成机制及肝硬化程度与门静脉血流动力学的动态变化。一、材料与方法１．研究对象：４１例肝硬化患者,经肝穿刺活检或临床、实验室及超声检查确诊,均系肝炎后肝硬化伴有食管静脉曲张,超声探及门静脉系统有血栓形成者不纳人本组（经胃镜或吞钡ＸＶ线透视证实）。肝功能按Ｃｈｉｌｄ－Ｐｕｇｈ分级：Ａ级１３例,Ｂ级１８例,Ｃ级１０例。５０例正常作为对照。２．方法：采用ＴｏｓｈｉｂａＳＳＡ－２７０…     

肝硬化大鼠内脏血管组织内皮素及其基因表达的研究

目的探讨肝硬化大鼠内脏血管组织中,内皮素（ＥＴ）及其基因表达量的变化在门静脉高压形成机制中的意义。方法用放射免疫法分别测定大鼠血浆以及门静脉（ＰＶ）和肠系膜上动脉（ＳＭＡ）组织中ＥＴ含量,采用ＲＴ－ＰＣＲ技术分析ＰＶ和ＳＭＡ组织中ＥＴｍＲＮＡ表达量的变化。结果ＰＶ和ＳＭＡ组织中ＥＴ及其ｍＲＮＡ表达量,肝硬化组均显著高于正常对照组（均为Ｐ＜０．００１）;而肝硬化大鼠血管组织ＥＴ含量及ＥＴｍＲＮＡ表达量,则为ＰＶ明显高于ＳＭＡ（＜０．０５）,但正常对照组动静脉之间差异无显著性（Ｐ＞００５）。另外,内脏动静脉血管ＥＴ含量之差与门静脉压力呈显著的正相关。结论ＥＴ可能通过更多的收缩内脏静脉特别是门静脉,增加门静脉血流阻力而参与门静脉高压的形成。     

老年人不同体质对心脏结构、血流、功能及血压的影响

目的观察体重对老年人心血管系统的影响。方法６２３例老年人根据体质指数（ＢＭＩ）分为肥胖、超重、正常及消瘦４组，检测血压、空腹血糖（ＢＳ）、胆固醇（ＴＣ）、甘油三酯（ＴＧ）及超声心动图。结果肥胖及超重组较正常体重及消瘦组收缩压（ＳＢＰ）及舒张压（ＤＢＰ）均增高（均为Ｐ＜０．０５），主动脉径（ＡｏＤ）、左房径（ＬＡＤ）、左室舒张及收缩末径（ＥＤＤ及ＥＳＤ）及心肌质量（ＬＶＭ）增加（均为Ｐ＜０．０５）。ＳＢＰ、ＤＢＰ均与体重、ＢＭＩ、ＴＣ、ＬＶＭ及心房收缩期与舒张早期充盈峰值流速（ＡＰＦＶ与ＥＰＦＶ）之比值（Ａ／Ｅ）呈明显正相关（Ｐ＜０．０５、０．０１或０．００１），ＤＢＰ与年龄呈明显负相关（Ｐ＜０．００１）。多元逐步回归分析证实ＬＶＭ、ＡＰＦＶ及ＬＡＤ均与ＢＭＩ呈正相关（均为Ｐ＜０．０１），ＥＰＦＶ与ＢＭＩ呈负相关（Ｐ＜０．０５）；射血分数（ＥＦ）、年龄、ＢＳ与ＳＢＰ呈正相关（Ｐ＜０．０５、０．００１及０．０１），与ＤＢＰ呈负相关（Ｐ＜０．０５或０．００１）。结论体重是影响心脏结构、血流、功能及血压的重要因素；ＥＦ、年龄、ＢＳ是分别影响ＳＢＰ及ＤＢＰ的独立因素。     

食道曲张静脉套扎术对肝硬化患者门静脉血流动力学的影响

目的：了解食道曲张静脉套扎术（ＥＶＬ）后门静脉血流动力学改变与临床的关系。方法：采用彩色多普勒对２５例肝硬化患者内镜下ＥＶＬ前后的门静脉血流动力学改变进行测定。结果：ＥＶＬ治疗２周后肝硬化患者门静脉、脾静脉内径（ＰＤ、ＳＤ）、门静脉血流速度及血流量（ＰＶ、ＰＱ．ＳＱ）较治疗前明显增加（Ｐ值＜０．０１），脾静脉血流速度（ＳＶ）明显减慢（Ｐ值＜０．０１）。结论：ＥＶＬ能短时间升高门静脉压，部分地加重ＰＨＧ和ＬＦ。     

肝硬化并门静脉高压测定吲哚青绿提取率与门静脉血流方向之临床意义

对２２例肝硬化门静脉高压有胃－食管静脉曲张出血史之患者，用吲哚青绿（ＩＣＧ）一次静脉注射后，同时测定肝静脉和股动脉或门静脉血中ＩＣＧ浓度，算出其零时位的肝提取率（ＥＲ）；继之做门静脉造影观测门静脉血流方向（ＰＢＦＤ）。本文以ＥＲ≥４３％定为肝功能良好组（ｎ＝１１），大多数为向肝性血流（８１．８％）；以ＥＲ＜４３％为肝功能不良组（ｎ＝１１），多数为离肝性血流（６３．６％），可见ＥＲ与ＰＢＦＤ密切相关。对ＥＲ≥４３％和／或ＰＢＦＤ为向肝性之１０例进行了手术，术后均良好；ＥＲ＜４３％又为离肝性或双向性血流之９例作硬化疗法或栓塞术，１０个月内已死亡５例。结论：ＥＲ和ＰＢＦＤ对评定肝功能贮备是有用的指标，对手术适应症的选择和预后的估价较Ｃｈｉｌｄ分级更可信，更有价值。     

肝硬化患者门脉系统血流动力学指标与Child-Pugh分级的相关性研究

研究肝硬化患者脾静脉和门静脉血流量及其比值(Qsv/QPv)与肝脏储备功能Child-Pugh分级的关系.采用彩色多普勒超声仪对168例肝炎后肝硬化患者(ChildA级43例,B级67例,C级58例)和59例健康成年人检测了门静脉、脾静脉的内径、流速,再计算出相关的血流量,并进行了比较分析.结果显示,随着Qsv/Qpv的升高,肝硬化患者的肝功能不断下降,各组之间比较有非常显著性差异(P＜0.01).肝硬化患者肝功能损害越重,脾静脉血流量占门静脉血流量的比值越高.如果将Qsv/Qpv的截断值定于40%,则其提示肝硬化患者肝功能下降至B级或以下的敏感性、特异性、准确性分别达80.80%、74.42%和79.17%.彩色多普勒超声测量门静脉系统及其血流动力学指标用于判断肝硬化患者的肝功能状态是一个较好的临床手段.     

Clinical and experimental study of effect of Raondix Salviae Militiorrhiza and other blood-activating and stasis-eliminating Chinese herbs on hemodynamics of portal hypertension

ＩＮＴＲＯＤＵＣＴＩＯＮＴｈｅｒｅｈａｓｂｅｅｎｎｏｌｏｎｇｌａｓｔｉｎｇａｎｄｓｉｄｅｅｆｆｅｃｔｓｆｒｅｅｄｒｕｇｓｔｏｌｏｗｅｒｔｈｅｐｏｒｔａｌｈｙｐｅｒｔｅｎｓｉｏｎｉｎｐａｔｉｅｎｔｓｗｉｔｈｌｉｖｅｒｃｉｒｒｈｏｓｉｓｓｏｆａｒ．Ｔｈ...     

奥曲肽对肝硬化门脉血流动力学的影响

目的 通过观察不同剂量生长抑素衍生物奥曲肽对肝硬化门脉高压性食管静脉曲张患者门静脉系统血流动力学变化的影响,同时与作用肯定的β受体阻滞剂心得安比较,尝试证实奥曲肽在预防肝硬化食管静脉曲张再出血维持治疗中的作用。方法 2001年1～12月期间,30例肝炎后肝硬化并食管静脉中～重度曲张的住院患者,随机分为3组：A组10例,心得安10～20mg、每日3次口服,7d。B组10例,奥曲肽0．05mg、每12h皮下注射,3d。C组10例,奥曲肽0．1mg、每12h皮下注射,3d。运用彩色多普勒血管超声技术探测上述3组患者给药前、后门静脉(PV),脾静脉(SV)及肠系膜上静脉(SMV)的血管内径及最大流速,并计算各静脉的平均流速和推导其血流量。结果 3组用药前后对血管直径均无影响;心得安组可降低PV的流速及流量,但对SV和SMV的流速及流量均无影响;不同剂量奥曲肽组均可分别降低PV、SV和SMV的流速及流量。此外,对PV流量的改变,奥曲肽0．1mg组优于心得安组,但奥曲肽0．05mg组与心得安组无差异;对SV及SMV流量的改变,不同剂量奥曲肽组均优于心得安组。结论 奥曲肽对预防门脉高压性食管静脉曲张再出血具有潜在的维持治疗作用。     

丹参等活血化淤中药对门脉高压血流动力学影响的临床与实验研究

目的探讨丹参、当归等及硝苯啶对门脉高压血流动力学的影响。方法采用血管插管测定胆管结扎肝硬化犬门脉系统压力变化；超声多普勒观测肝硬化患者门脉血流动力学变化。结果（１）静脉滴注丹参、当归后，肝硬化犬门静脉压（Ｐｐｖ）、嵌塞肝静脉压（ＷＨＶＰ）、肝静脉压力梯度（ＨＶＰＧ）显著降低（Ｐ＜０．０５～０．０１），平均动脉压（ＭＡＰ）、心率（ＨＲ）无明显变化（Ｐ＞０．０５），硝苯啶则使Ｐｐｖ，ＷＨＶＰ，ＭＡＰ．ＨＲ显著降低（Ｐ＜０．０５）。（２）丹参、丹参＋硝苯啶．丹参＋水＋硝苯啶口服药１０－１２周，能显著降低肝硬化患者门静脉内径（Ｄｐｖ）、脾静脉内径（Ｄｓｖ）．门静脉血流量（Ｑｐｖ），脾静脉血流量（Ｑｓｖ）（Ｐ＜０．０５－０．０１，当归作用较弱。结论对比表明，丹参、当归等中药较硝苯啶对门脉压力作用为慢，但较持久，无副反应。     

Role of liver function and portal vein congestion index on rebleeding in cirrhotics after distal splenorenal shunt

BACKGROUND: Bleeding from esophagogastric varices is the worst and most lethal complication of cirrhotic portal hypertension. Distal splenorenal shunt (Warrens surgery) is used in the therapeutic of this patients, Child A and B, with rebleeding after clinical endoscopic therapy. The portal vein congestion index is elevated in cirrhotic portal hypertension and could predict rebleeding after Warrens surgery in these patients. AIM: To verify if the portal vein congestion index or liver function (Child-Pugh) at preoperative are predictive factors of rebleeding after Warrens surgery. METHODS: Sixty-two cirrhotic patients were submitted to Warrens surgery at "Santa Casa" Medical School and Hospital - Liver and Portal Hypertension Unit, S?o Paulo, SP, Brazil. Fifty-eight were analyzed for Child-Pugh class and 36 for portal vein congestion index, divided in two groups: with or without rebleeding and statistical analysis was performed. RESULTS: In the rebleeding group, 69% were Child B, with portal vein congestion index = 0.09. The group without rebleeding show us 62% patients Child A with portal vein congestion index = 0.076. The difference was significant for Child-Pugh class but not to portal vein congestion index. CONCLUSION: Portal vein congestion index was not predictive of rebleeding after Warrens surgery, but cirrhotics Child B have more chance to rebleed after this surgery than Child A.     

无创心脏血流动力检测对乙型肝炎肝硬化预后的评价价值

目的无创血流动力检测法研究不同阶段乙型肝炎肝硬化患者心脏血流动力学变化,探讨心脏泵功能与肝硬化预后的关系。方法 20例慢性乙型肝炎患者作为对照,以45例乙型肝炎肝硬化患者为研究对象,根据Child-Pugh分级分为A级组(12例)、B级组(17例)和C级组(16例),根据食管静脉曲张程度分为轻度组(10例)、中度组(17例)和重度组(18例),根据病毒载量分为高病毒载量组(105拷贝/ml)(19例)和低病毒载量组(≤105拷贝/ml)(26例),采用无创血流动力检测仪测定心脏血流动力学参数。结果随着肝功能恶化,平均动脉压(MAP)、每搏出量(SV)、每搏指数(SI)、心输出量(CO)、心脏指数(CI)、左心作功(LCW)和左心作功指数(LCWI)呈降低趋势,其中C级组明显低于A级组(P<0.05)。随着食管静脉曲张程度的加重,MAP、SV、SI、CO、CI、LCW和LCWI呈降低趋势,其中重度组明显低于轻度组(P<0.05)。不同病毒载量组间MAP、SV、SI、CO、CI、LCW和LCWI差异无统计学意义(P>0.05)。结论心脏血流动力学参数可有效判断乙型肝炎肝硬化病变进展程度,心脏泵功能随肝硬化Child-Pugh分级升高及食管静脉曲张程度加重呈进行性减退。     

肝硬化食道静脉曲张的门脉血流动力学改变及相关参数的研究分析

目的通过探讨乙肝肝硬化食道静脉曲张患者的门脉血流动力学改变,遴选敏感预测食道静脉曲张程度的相关彩色多普勒指标。方法肝硬化组80例,对照组30例,均经内镜检查,将食道静脉曲张程度分为轻、中、重度。彩色多普勒超声（CDFI）测定门静脉主干（PV）、脾静脉（SV）、肠系膜上静脉（SMV）及胃左静脉（LGV）四条静脉血管内径（D,cm）、平均血流速度（V,cm/min）,血流量（Q,ml/min）。结果 1.肝硬化组VPV、VSV、VSMV较对照组明显减低、VLGV的流速较对照组明显增快,DPV、DSV、DSMV、DLGV较对照组增宽,Qsv、Qpv、QLGV、QSMV均较对照组明显增多,肝硬化组Qsv/Qpv为54.5%,高于对照组的30.3%。2.随食道静脉曲张程度的加重,DPV逐渐增加、VPV逐渐下降、DLGV、VLGV、QLGV均明显增加,重度组均可见＂红色征＂,其中（＋＋）者为92.3%（36/39）。3.对照组LGV血流均呈向肝型,在肝硬化组中可见向肝、离肝、双向三种血流方向,肝硬化组中81.25%为离肝型血流,5%为双向型血流,13.75%为向肝型血流,其中重度组的离肝型血流比例高达94.9%。结论肝硬化门脉高压时PV、SV、SMV及LGV的血流动力学均有明显的改变,可作为判断食道静脉曲张程度的敏感、无创性诊断指标,其中LGV血流动力学指标在判断重度食道静脉曲张方面具有更重要的临床价值。     

多普勒彩超评估甲氧乙心安联合硝酸异山梨醇酯治疗门静脉高压的效果

目的：评估甲氧乙心安（商品名：倍他乐克）联合硝酸异山梨醇酯（商品名：消心痛）预防肝硬化患者上消化道出血和再出血的效果与安全性。方法：应用多普勒彩超检测２２例肝硬化门静脉高压患者经倍他乐克联合消心痛治疗前后门静脉系统血流动力学变化，并观察治疗前后血压、心率及肝功能变化。结果：治疗前门静脉主干、脾静脉及肠系膜上静脉平均内径较正常组明显增宽，平均血流速度明显减慢，平均血流量明显增多。治疗后三者平均内径无明显变化（Ｐ＞０．０５），但与治疗前比较，平均流速明显减慢，平均血流量明显减少（Ｐ＜０．０５）。结论：倍他乐克联合消心痛降门静脉压治疗安全有效。多普勒彩超对门静脉高压的诊断和治疗评估有重要意义。     

Portal hemodynamics in idiopathic portal hypertension (Banti's syndrome). Comparison with chronic persistent hepatitis and normal subjects

A comparative study of portal hemodynamics was made in 17 patients with idiopathic portal hypertension, 5 patients with chronic persistent hepatitis having no portal hypertension, and 21 healthy adults who served as the control for certain measurements. Venous pressures were measured by portal and hepatic vein catheterizations, blood flow by the pulsed Doppler flowmeter, organ volume by computed tomography, and intrahepatic shunt index by 99mTc-macroaggregated albumin instilled in the portal vein. The patients with idiopathic portal hypertension were divided into two groups: group A (n = 8) and group B (n = 9), consisting of those who respectively had portal venous flow per liver volume above and below the mean + 2 SD of healthy adults. In group A, portal vein pressure was moderately elevated, portal venous flow was significantly increased compared with the control, and portal vascular resistance was not much altered. In group B, portal vein pressure was markedly elevated above that of control, portal venous flow was comparable, and portal vascular resistance was significantly elevated. Splenic venous flow measured in the splenic vein between the left and short gastric veins was markedly increased in groups A and B, the increase being greater in the former. It was concluded that in some patients with idiopathic portal hypertension, increased portal venous flow, partly a result of increased splenic venous flow secondary to splenomegaly of an undetermined process, is the main contributor initially to the elevation of portal vein pressure; in others, possibly later, increased portal vascular resistance plays an important role.     

Effects of angiotensin-converting enzyme inhibitors and sclerotherapy on portal hemodynamics in patients with portal hypertension

BACKGROUND/AIMS: Since pharmacotherapy of portal hypertension has always been a subject of wide interest, we decided to study the effects of different angiotensin-converting enzyme inhibitors and endoscopic sclerotherapy on portal hemodynamics in patients with portal hypertension and bleeding esophageal varices. METHODOLOGY: The study included 72 patients with portal hypertension divided into 6 equal groups. Endoscopic sclerotherapy was done to all patients every 2 weeks for 3 months. In addition, the first 5 groups of patients were maintained on angiotensin-converting enzyme inhibitors for 3 months as follows: group I on perindopril, II on ramipril, III on fosinopril, IV on lisinopril and V on captopril. Portal hemodynamics were determined before and after therapy (using an ultrasonic duplex system). New Doppler portal indices were derived and portal vein kinetic pressure was estimated for the first time by using data derived from the ultrasonic duplex system. RESULTS: 1) Short-term endoscopic sclerotherapy alone resulted in significant elevation of portal vein kinetic pressure, wall stress index and flow volume (P < 0.01) and non-significant increase in the total portal circulation resistance index (P > 0.05) and significantly decreased portal vein compliance and distensibility indices (P < 0.05); 2) Angiotensin-converting enzyme inhibitors reduced the maximum and average portal velocities, the portal flow volume, total portal circulation resistance index and increased portal vein compliance and distensibility indices, hence they reduced the portal vein kinetic pressure significantly in group IV (P < 0.05 for the flow volume and P < 0.01 for other indices); 3) The only side effect encountered was allergic cough (in 8.33% of patients). No effects were noticed on the pulse, systolic, diastolic or mean blood pressures or Child-Pugh Score of liver disease. CONCLUSIONS: 1) Angiotensin-converting enzyme inhibitors when added to endoscopic sclerotherapy can ameliorate the effects of the latter on portal hemodynamics in patients with portal hypertension; 2) Portal vein kinetic pressure, total portal circulation resistance index, portal vein wall stress index, compliance and distensibility indices are new Doppler portal indices that proved to be of value in the follow-up of patients with portal hypertension under sclerotherapy alone or in conjunction with pharmacotherapy; 3) Angiotensin-converting enzyme inhibitors are safe drugs that can be used for portal decompression with endoscopic sclerotherapy. Their use as sole portal anti-hypertensive agents still awaits further studies.