三氯乙烯药疹样皮炎患者肝脾声像及血流动力学改变的研究

Research on ultrasonographic and hemodynamic changes of liver and spleen in patients with trichloroethylene medicamentous dermatitis

目的探讨三氯乙烯(TCE)药疹样皮炎患者肝脾声像及血流动力学改变及其临床意义。方法应用彩色多普勒超声显像仪,检测了50例(男31例,女19例)TCE药疹样皮炎(TCEMD)住院病人,全部病例经过广东省职业病防治院诊断确诊,检测指标有:肝中静脉内径(HVD)及血流频谱,门静脉内径(PVD)及血流量(PVQ),肝实质回声,肝右叶最大斜径(RLH),脾脏厚度及长径(SPT,SPL),脾静脉内径(SPVD),脾静脉血流量(SVQ),脾静脉最大流速(SPVx)。选择同期来我院的健康体检者50例(男30例,女20例)作为对照组。结果除HVD和PVQ外,TCEMD患者上述所有指标均高于正常人,与对照组比较差异有显著性(P<0.01);HVD和PVQ低于正常人,与对照组比较差异有显著性(P<0.01)。结论TCEMD早期即可出现肝脾声像及血流动力学改变,对肝脾静脉进行超声多普勒血流检测可以作为TCEMD的一项定量性检测手段,为TCEMD患者肝损害的诊断和治疗提供帮助和依据,具有一定的临床实用价值。

Objective To study the ultrasonographic and hemodynamic changes of liver and spleen in patients with trichloroethylene（TCE） medicamentous dermatitis and their clinical significance. Methods 50 patients （31 men and 19 women） with TCE medicamentous dermatitis in our hospital were observed with color Doppler system （General LOGIQ7 ）. All patients were confirmed by Guangdong diagnosis group for occupational disease. The observed indexes included hepatic vein diameter（HVD） and Doppler waveform changes, portal vein diameter（PVD） and portal blood flow（ PVF or PVQ）, ultrasonic integrated backscatter（IBS） of liver, maximal diagonal of lobus hepatic, spleen thickness and longitudinal length（ SPT, SPL）, spleen vein diameter （ SPVD）, spleen vein blood flow（ SPVF or SPVQ）, maximum blood velocity of splenic vein（SPVx）. 50 persons （ 30 men and 20 women） without hepatic and viscera diseases and non-exposed to liver toxic materials were selected as the control. Results All indexes metioned above except HVD and SPVQ were significantly higher in patients with TCE medicamentous dermatitis than those of the control（P 〈0.01 ）. The values of HVD and SPVQ were lower than those of the control, the differences were significant（P 〈 0.01）. Conclusion The changes of ultrasonography and hemodynamics for liver and spleen might be early existed. Doppler ultrasonography and hemodynamic test for liver and spleen vein might be used as a quantitative detection for TCE medicamentous. Ultrasonography can provide evidence for diagnose and therapy of TCE medicamentous, showing certain clinical value. The occurrence ratio of hepatic dysfunction with TCE medicamentous dermatitis was high and severe. Ultrasonography of abdomen especially portal vein blood flow has characteristic changes. The portal vein blood flow can be used as one of the indexes of liver function.