CEUS评价失代偿期肝硬化门静脉高压及血流动力学参数的价值
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摘要
目的:探讨对比增强超声(CEUS)评价失代偿期肝硬化患者门静脉高压和门静脉血流动力学参数的变化及其意义。方法:选取在医院确诊的70例失代偿期肝硬化患者纳入病例组,另选70名健康志愿者作为健康对照组,采用CEUS检测并观察比较两组的门静脉内径(Dpv)、门静脉平均血流速度(PVV)、肝动脉阻力系数(HARI)、脾动脉阻力指数(SPARI)、肝动脉内造影剂到达时间(HAAT)、肝静脉内造影剂到达时间(HVAT)、HAAT与HVAT之差值(HA-VVT)、肝实质达峰时间(Tpeak)、门静脉灌注时间(Tp)、肝动脉-门静脉灌注强度比(Ia/Ip)、肝动脉-肝实质峰值强度比(Ia/Ipeak)和门静脉高压。结果:病例组的Dpv、SPARI显著高于健康对照组,其差异有统计学意义(t=19.525,t=12.798;P<0.05),PVV、HARI显著低于健康对照组,其差异有统计学意义(t=-24.428,t=10.967;P<0.05);HAAT、HVPG显著高于对照组,其差异有统计学意义(t=-3.325,t=14.029;P<0.05),病例组的HVAT、HA-VVTI显著低于对照组,其差异有统计学意义(t=-15.187,t=-21.367;P<0.05);病例组的Ia/Ip、Tp显著高于对照组,其差异有统计学意义(t=23.397,t=6.972;P<0.05),Tpeak、Ia/Ipeak显著低于对照组,其差异有统计学意义(t=-11.379,t=-21.145;P<0.05);失代偿期肝硬化患者的HVAT、HA-VVTI与HVPG呈显著的负相关关系(r=0.611、r=-0.578;P<0.05),HAAT与PHT无显著的相关关系(r=0.271,P>0.05)。结论:采用CEUS评价失代偿期肝硬化患者门静脉高压症(PHT)病情、门静脉血流动力学具有较重要的临床价值,同时具有无创的优势。
Objective: To investigate that contrast-enhanced ultrasound(CEUS) evaluated the changes of portal hypertension and portal hemodynamic parameters of patients with decompensated cirrhosis and its significance. Methods: Seventy patients with decompensated cirrhosis who were diagnosed in hospital were enrolled in the case group, and another 70 healthy volunteers were selected in the healthy control group. CEUS was adopted to detect, observe and compare the portal vein diameter(Dpv), portal vein mean blood flow velocity(PVV), hepatic artery resistance index(HARI), splenic artery resistance index(SPARI), intra-hepatic artery contrast agent arrival time(HAAT), hepatic vein contrast agent arrival time(HVAT), difference of HAAT and HVAT(HA-VVT), liver parenchyma peak time(Tpeak), portal vein perfusion time(Tp), the ratio of perfusion intensity between hepatic artery and portal vein(Ia/Ip), the ratio of peak value intensity between hepatic artery and liver parenchyma peak(Ia/Ipeak) and portal hypertension(PHT) of the two groups. Results: The Dpv and SPARI in case group were significantly higher than those in healthy control group(t=19.525, t=12.798, P<0.05), and the PVV and HARI of case group were significantly lower than those of healthy control group(t=-24.428, t=10.967, P<0.05), respectively. And the HAAT and HVPG in case group were significantly higher than those in control group(t=-3.325, t=14.029, P<0.05).The HVAT and HA-VVT I in case group were significantly lower than those in control group(t=-15.187, t=-21.367, P<0.05). The Ia/Ip and Tp in case group were significantly higher than those in control group(t=23.397, t=6.972, P<0.05). And the Tpeak and Ia/Ipeak of case group were significantly lower than those of control group(t=-11.379, t=-21.145, P<0.05). There was a significant negative correlation between HVAT, HA-VVTI and HVPG of patients with decompensated cirrhosis(r=0.611, r=-0.578, P<0.05). There was no significant correlation between HAAT and PHT(r=0.271, P>0.05). Conclusion:CEUS that is used to evaluate the situation of portal hypertension and hemodynamics of portal vein of patients with decompensated cirrhosis has more important clinical value and its other advantages is non-invasive.
Objective: To investigate that contrast-enhanced ultrasound(CEUS) evaluated the changes of portal hypertension and portal hemodynamic parameters of patients with decompensated cirrhosis and its significance. Methods: Seventy patients with decompensated cirrhosis who were diagnosed in hospital were enrolled in the case group, and another 70 healthy volunteers were selected in the healthy control group. CEUS was adopted to detect, observe and compare the portal vein diameter(Dpv), portal vein mean blood flow velocity(PVV), hepatic artery resistance index(HARI), splenic artery resistance index(SPARI), intra-hepatic artery contrast agent arrival time(HAAT), hepatic vein contrast agent arrival time(HVAT), difference of HAAT and HVAT(HA-VVT), liver parenchyma peak time(Tpeak), portal vein perfusion time(Tp), the ratio of perfusion intensity between hepatic artery and portal vein(Ia/Ip), the ratio of peak value intensity between hepatic artery and liver parenchyma peak(Ia/Ipeak) and portal hypertension(PHT) of the two groups. Results: The Dpv and SPARI in case group were significantly higher than those in healthy control group(t=19.525, t=12.798, P<0.05), and the PVV and HARI of case group were significantly lower than those of healthy control group(t=-24.428, t=10.967, P<0.05), respectively. And the HAAT and HVPG in case group were significantly higher than those in control group(t=-3.325, t=14.029, P<0.05).The HVAT and HA-VVT I in case group were significantly lower than those in control group(t=-15.187, t=-21.367, P<0.05). The Ia/Ip and Tp in case group were significantly higher than those in control group(t=23.397, t=6.972, P<0.05). And the Tpeak and Ia/Ipeak of case group were significantly lower than those of control group(t=-11.379, t=-21.145, P<0.05). There was a significant negative correlation between HVAT, HA-VVTI and HVPG of patients with decompensated cirrhosis(r=0.611, r=-0.578, P<0.05). There was no significant correlation between HAAT and PHT(r=0.271, P>0.05). Conclusion:CEUS that is used to evaluate the situation of portal hypertension and hemodynamics of portal vein of patients with decompensated cirrhosis has more important clinical value and its other advantages is non-invasive.
引文
[1]卢春雨,唐少珊.彩色多普勒超声与超声造影对经颈静脉肝内门体分流术后支架功能的评价作用[J].临床肝胆病杂志,2017,33(5):959-962.
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[8]Zhang H,Sun Q,Mao W,et al.Neutrophil-toLymphocyte Ratio Predicts Early Mortality in Patients with HBV-Related Decompensated Cirrhosis[J].Gastroenterol Res Pract,2016,2016:4394650.
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[10]M?ller S,Bendtsen F,Henriksen JH.Splanchnic and systemic hemodynamic derangement in decompensated cirrhosis[J].Can J Gastroenterol,2001,15(2):94-106.
[11]曹辉,牛犇,王海燕,等.对比超声造影检查与MR增强扫描在肝内胆管癌诊断中的临床价值[J].中国医学装备,2018,15(2):58-61.
[12]江尧彬,叶新华.高频超声下的胆囊壁厚度与肝硬化失代偿患者门静脉系统血流动力学改变的相关性研究[J].中西医结合肝病杂志,2016,26(6):358-360.
[13]龚江波,吴利达,金学林,等.再改良Sugiura术对肝硬化门静脉高压症患者门静脉血流动力学及肝功能的影响[J].中华肝胆外科杂志,2017,23(2):90-94.
[14]李龙辉,任战领.彩色多普勒超声对肝硬化上消化道出血患者门静脉血流动力学改变的诊断价值[J].中国医学装备,2016,13(5):87-90.
[15]李泽达,LiZeda.肝硬化门静脉高压症血流动力学影像评估的现状与未来[J].中国医师杂志,2016,18(5):785-789.
[16]庄园,丁红,韩红,等.超声造影评价失代偿期肝硬化患者门静脉高压的临床价值[J].中华肝脏病杂志,2016,24(4):270-274.
[2]郁素云,王磊,瞿美君.彩超在肝外型门静脉高压症中的临床诊断价值及肝血管指数的分析[J].中华全科医学,2016,14(3):465-467.
[3]马莹贺,唐少珊,刘站,等.超声造影评价门静脉高压症[J].中国医学影像学杂志,2016,24(3):195-198.
[4]吴乃安,周亮.超声造影肝实质灌注峰值强度反映肝硬化肝实质血流灌注变化的准确性[J].肝脏,2016,21(6):474-477.
[5]刘桂红,严志涵.彩超下肝硬化门脉血流动力学改变与食管静脉曲张破裂出血的关系研究[J].临床和实验医学杂志,2016,15(23):2338-2341.
[6]Reiberger T,Mandorfer M.Beta adrenergic blockade and decompensated cirrhosis[J].J Hepatol,2017,66(4):849-859.
[7]翟亚楠,李雷,殷亮,等.双源CT全肝低剂量灌注成像对肝硬化门静脉高压患者经颈静脉肝内门体分流术后肝血流灌注的评估价值[J].临床肝胆病杂志,2016,32(10):1894-1899.
[8]Zhang H,Sun Q,Mao W,et al.Neutrophil-toLymphocyte Ratio Predicts Early Mortality in Patients with HBV-Related Decompensated Cirrhosis[J].Gastroenterol Res Pract,2016,2016:4394650.
[9]杨卫生,郭武华.肝硬化门静脉高压症患者肝脏血流动力学指标与门静脉压力的相关性研究[J].中国全科医学,2016,19(23):2784-2788.
[10]M?ller S,Bendtsen F,Henriksen JH.Splanchnic and systemic hemodynamic derangement in decompensated cirrhosis[J].Can J Gastroenterol,2001,15(2):94-106.
[11]曹辉,牛犇,王海燕,等.对比超声造影检查与MR增强扫描在肝内胆管癌诊断中的临床价值[J].中国医学装备,2018,15(2):58-61.
[12]江尧彬,叶新华.高频超声下的胆囊壁厚度与肝硬化失代偿患者门静脉系统血流动力学改变的相关性研究[J].中西医结合肝病杂志,2016,26(6):358-360.
[13]龚江波,吴利达,金学林,等.再改良Sugiura术对肝硬化门静脉高压症患者门静脉血流动力学及肝功能的影响[J].中华肝胆外科杂志,2017,23(2):90-94.
[14]李龙辉,任战领.彩色多普勒超声对肝硬化上消化道出血患者门静脉血流动力学改变的诊断价值[J].中国医学装备,2016,13(5):87-90.
[15]李泽达,LiZeda.肝硬化门静脉高压症血流动力学影像评估的现状与未来[J].中国医师杂志,2016,18(5):785-789.
[16]庄园,丁红,韩红,等.超声造影评价失代偿期肝硬化患者门静脉高压的临床价值[J].中华肝脏病杂志,2016,24(4):270-274.