婴儿肝炎综合征肝纤维化程度的超声血流动力学改变与病理对照研究

COMPARATIVE STUDY ON HEPATIC HEMODYNAMICS BY DOPPLE ULTRASONOGR-APHY AND HISTOPATHOLOGIC CHANGES IN INFANT HEPATITIS SYNDROME

目的:探讨超声血流动力学改变对婴儿肝炎综合征(婴肝征)肝纤维化程度的诊断价值.方法:用超声检测41例婴肝征及70例健康婴儿肝脏血流动力学,并对41例婴肝征行肝病理检查,并按病理肝纤维化程度分组进行单因素方差分析和相关分析.结果:41例行肝活检或手术患儿主要病理改变以肝纤维结缔组织增生最常见,占39例次(95.1%),S1～S3者24例,S4者15例.肝固有动脉(PHA)收缩期峰值速度(Vs)、舒张末期流速(Vd)、阻力指数(RI)测值和PHAVs/PVVmax在轻、中、重度肝纤维化组逐渐增高,Vs、RI、PHAVs/PVVmax与肝纤维化程度呈正相关(r分别为0.719和0.748,0.700,P<0.001);肝静脉(HV)多普勒频谱波形与肝纤维化程度亦呈正相关(r=0.787,P<0.001).结论:超声检测PHA的Vs、RI和PHAVs/PVVmax,以及HV多普勒频谱波形改变是反映婴肝征肝纤维化程度较敏感的指标.

Objective：This study was designed to explore the relationship between hepatic fibrosis in infants with hepatitis syndrome （IHS） and hepatic hemodynamic parameters by noninvasive ultrasonography. Methods： Forty one Patients with IHS （IHS group） and seventy health infants （control group） were examined by ultrasonography. All of them had the findings of histopathological examination. Result：In IHS group, the most common histopathological changes in samples from biopsy or surgical resection are the liver fibrosis, which could be found in 95.1%（39/41） of the patients, 24 of 41 patients were classified as the grade of S1-S3 and 15 patients were S4. The values of proper hepatic artery （PHA）, Peak systolic velocity （Vs）,end diastolic velocity （Vd）,resistant index （RI） and the ratio of PHAVs/PVVmax significantly increase and have the positive relationship （γ = 0. 719 and 0. 748,respectively, P〈 0. 001） with the severity of liver fibrosis. Furthermore ,the Doppler spectrum patterns of hepatic vein transform from normal HV0 into abnormal HV1 and HV2,concentrations of serum fibrosis marker in IHS group also significantly increase compared with those of control group. Conclusion：The results suggest that hepatic hemodynamics could reveal the activity of hepatic fibrosis, and these parameters could clinically serve as an useful marker for diagnosis of IHS.