超声无创评估肝硬化门静脉高压患者门静脉压力变化趋势

Noninvasive evaluation on portal pressure change in patients with portal hypertension by ultrasound

  • 摘要: 目的 分析肝硬化门静脉高压(portal hypertension,PHT)患者超声多普勒血流动力学综合参数的特点,以及各参数与术中直测门静脉压力的关系。方法 选取2008-2016年经唐都医院临床诊断为PHT并于普通外科接受手术治疗的患者57例为研究对象,其中男42例,女15例,平均年龄47岁。术中测量门静脉压力,彩色超声多普勒采集门静脉充血指数(congestion index,CI)、肝缓冲指数(hepatic buffer index,HBI)、肝血管指数(liver vascular index,LVI)和PHT指数(PHT index,PHI),分析各参数与门静脉压力相关性。选取25名健康成年人作为对照组并测量上述指标,比较两组各项参数差异。结果 PHT患者CI与PHI显著高于健康对照组CI:(0.127±0.067)cm/s vs(0.045±0.035)s/m;PHI:(2.093±0.506)s/m vs(1.393±0.520)cm/s;P均<0.01,HBI1.389±0.813)min/L vs(3.728±0.541)min/L和LVI(10.308±3.260)cm/vs(16.257±5.760)cm/s则显著低于对照组(P均<0.05)。术中直测门静脉压力与LVI呈显著负相关(r=-0.501;P=0.003),而与HBI呈显著正相关(r=0.441;P=0.009),与肝功能Child-P ugh评分显著正相关(r=0.589;P=0.044)。结论 彩色多普勒超声可无创评估PHT的进展,随着门静脉压力增加肝血管阻力增加,同时调动肝应激,通过增高肝动脉缓冲能力代偿血管阻力增加。

     

    Abstract: Objective To study the relationship between portal hemodynamic parameters obtained by Doppler ultrasonography and portal pressure measured directly during surgery in patients with portal hypertension(PHT). Methods Fifty-seven patients with a clinical diagnosis of PHT who received surgery in Tangdu Hospital from 2008 to 2016 were investigated.Of the 57 cases,there were42 males and 15 females with mean age of 47 years.The portal pressure was measured directly intraoperatively.Relevant parameters,including congestion index(CI)of the portal vein,hepatic buffer index(HBI),liver vascular index(LVI),and PHT index(PHI),were collected by color Doppler ultrasonography,and their relationships with portal pressure were analyzed.Another 25 healthy adults with gender and age matched were included as control subjects. Results The CI and PHI of PHT patients were significantly higher than those of the healthy control groupCI,(0.127±0.067)cm/s v.s(0.045±0.035)cm/s; HBI,(2.093±0.506)s/m vs(1.393 ±0.520)s/m;P<0.01,respectively.While HBI and LVI were significantly lower than those of control group(1.389±0.813)min/L v.s(3.728±0.541)min/L;(10.308±3.260)cm/s v.s(16.257±5.760)cm/s;P<0.05,respectively.Portal pressure and LVI was significantly negatively correlated(r=-0.501,P=0.003),while HBI was significantly positively correlated with portal pressure(r=0.441,P=0.009).In addition,portal pressure and Child-Pugh score of liver function(r=0.589,P=0.044)was significantly positively correlated. Conclusion Color Doppler ultrasonography can noninvasively evaluate the progress of PHT.With the increase of portal venous pressure,hepatic vascular resistance increases.At the same time,hepatic buffer capacity of hepatic artery is started to compensate for the increase of vascular resistance.

     

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