三氯乙烯药疹样皮炎患者脾血流动力学改变与肝纤维化指标的关系

Correlation between the Changes of Spleen Hemodynamics and Liver Fibrosis Markers in the Patients with Trichloroethylene Medioamentous Dermatitis

目的探讨三氯乙烯药疹样皮炎患者(TCEMD)脾脏血流动力学参数改变与肝纤维化指标的关系。方法选择30例三氯乙烯药疹样皮炎患者作为观察组,30例同时期健康体检者作为对照组,用彩色多普勒超声仪,检测脾脏厚度(SPT)及长径(SPL)、脾动静脉直径(SPAD,SPVD)、脾动静脉血流量(SPAQ、SPVQ)和脾静脉最大流速(SPVX)。用放射免疫法检测肝纤维化指标透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C-Ⅳ)和甘胆酸(CG)的水平,并对观察组与对照组的脾血流动力学参数与肝纤维化指标进行相关分析。结果TCEMD患者上述脾血流动力学参数均高于正常对照组(P<0.01);脾脏增大的患者脾动静脉血流参数均高于脾脏不大者(P<0.01);HA、PCⅢ、C-Ⅳ和CG观察组高于对照组(P<0.05);脾脏厚度,长径及SPVD与HA,PCⅢ、C-Ⅳ水平呈正相关,其余参数与肝纤维化指标无相关性。结论①TCEMD脾脏厚度及长径(SPT及SPL)、SPVD与肝纤维化指标有良好的相关性,这些参数比脾动静脉血流参数能更好地反映TCEHD肝纤维化病变的程度;②TCEMD患者可出现脾循环亢进,这一变化与脾脏动脉性充血有关。

[ Objective ] To explore the correlation between changes of spleen hemodynamics and liver fibrosis markers in the patients with trichloroethylene medicamentous dermatitis （TCEMD）. [ Methods]30 patients with trichloroethylene medicamentous dermatitis （TCEMD） and 30 normal persons were selected as the observation group and the control group respectively; color Doppler was used to detect the spleen thickness and longitudinal length （ SPT, SPL） , spleen vein and artery diameters （ SPVO, SPAD） , the maximum blood velocity and blood flow of spleen vein and artery （ SPVx, SPVQ, SPAQ ） ; RIA was applied to determine the serum levels of HA, LN, PC Ⅲ, C Ⅳ and CG; relevant analysis was made on the linear relationship between serum indices of hepatic fibrosis and spleen hemodynamics of the two groups. [ Results ] Spleen size and hemodynamic parameters of the TCEMD patients were significantly higher than that of the control （ P 〈0.01 ） ; serum levels of HA, LN, PCⅢ, C-Ⅳ and CG of the control were higher than that of the observation group （ P 〈0.05 ） ; SPT, SPL and SPVD had positive correlation with the liver fibrosis HA, PCⅢ, and C-Ⅳ, but other indices had no correlation with each other. [ Conclusion] There is sensitive correlation between spleen hemodynamics （SPT, SPL and SPVD） and liver fibrosis markers in TCEMD patients, which can better manifest the level of TCEHD liver fibrosis; TCEMD patients might have spleen hyperdynamic circulatory state due to active spleen congestion.