The plasma molar ratio of valine, leucine and isoleucine to phenylalanine and tyrosine as marker of portal-systemic shunt in liver cirrhosis.

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The relation between the plasma molar ratio of valine, leucine and isoleucine to phenylalanine and tyrosine and portal systemic shunt was examined by three kinds of studies in clinically stable cirrhosis.1) Using the method of percutaneous transhepatic portal vein injection of two different laveled macroaggregated albumins, total, intrahepatic and extrahepatic shunt index were measured in 14 cirrhosis. The good correlation existed between lowering of the ratio and increasing of each of total shunt index (r=-0.76, p<0.005) and intrahepatic shunt index (r=-0.76, p<0.005)2) Oral ammonia tolerance test was carried out in 15 cirrhosis. Increment of arterial blood ammonia level 30min after administration of ammonium chloride of 50mg/kg was correlated with the ratio significantly (r=-0.72, p<0.005).3) Changes of the ratio between encephalopathic and non-encephalopathic states were examined in 5 cirrhosis with chronic recurrrent hepatic encephalopathy who were demonstrated to have large portal collateral pathyway by the portography. The mean ratio was 0.79±0.09 on encephalopathic state and 0.82±0.12 on non-encephalopathic state, and no significant difference was existed between them.The results revealed the ratio is a good marker of the degree of portal-systemic shunt in stable cirrhosis. Marked lowering of the ratio suggests the presence of large portal-systemic shunt and easy development of encephalopathy.