长期使用拉米夫定对乙肝肝硬化门静脉系统血流动力学的影响

Effect of lamivudine on portal vein hemodynamics of patients with liver cirrhosis after hepatitis B

目的探讨长期使用拉米夫定治疗对代偿期乙肝肝硬化患者门静脉系统血流动力学的影响。方法选择使用拉米夫定治疗3～5年、治疗后肝功能持续稳定、HBVDNA持续阴性的33例代偿期乙肝肝硬化患者,使用彩色多普勒超声仪,分别测量患者在拉米夫定治疗前后的脾脏厚度、门静脉(PV)和脾静脉(SV)的内径(D)、最大流速(V),计算PV的血流量(Qpv)和SV的血流量(Qsv),并比较其前后变化。结果拉米夫定治疗前后患者的脾脏厚度分别为(5.3±1.6)cm和(4.5±1.3)cm(t=2.699,P<0.01);脾门静脉血流量分别为(596.13±277.71)ml/min和(587.88±214.26)ml/min(t=2.137,P<0.05);肝门静脉血流量分别为(1271.33±321.65)ml/min和(1207.14±296.77)ml/min(t=14.828,P<0.01)。结论代偿期乙肝肝硬化患者长期应用拉米夫定治疗后门静脉系统血流动力学指标得到显著改善。

Objective To investigate the effect of longTterm lamivudine therapy on portal system hemodynamics in patients with compensated liver cirrhosis secondary to hepatitis B. Methods The 33 patients with compensated liver cirrhosis were treated by lamivudine for 3--5 years. Before and after therapy, the spleen thickness and the parameters of portal vein （PV） and splenic vein（SV） ,including the inner diameter, the blood flow rate and the volume of blood flow were measured with color Doppler ultrasonography in all patients. Results Before and after treatment, the spleen thickness were （5.3±1.6）cm and （4.5±1.3）cm（t=2. 699,P〈0.01）, the volume of blood flow of splenic vein were （596.13±277.71）ml/min and （587.88±214.26）ml/min（t=2. 137,P〈0.05） ,and the volume of blood flow of portal vein were （1 271. 33±321.65） ml/min and （1 207.1±296.77） ml/min respectively（t=14. 828,P〈0.01）. Most parameters after therapy were obviously better than those before treatment. Conclusion The portal vein hemodynamics were significantly improved after long-term lamivudine therapy in patients with compensated liver cirrhosis resulting from chronic hepatitis B.