门静脉血流动力学和血清学纤维化指标评估肝纤维化的临床研究

The clinical study of liver fibrosis evaluated by portal vein hemodynamics and serum fibrosis markers

目的探讨慢性肝炎患者门静脉血流动力学和血清肝纤维化指标与肝纤维化病理分级的关系。方法测定67例慢性肝炎患者的门静脉血流动力学参数：直径、平静呼吸最大流速、平均流速、血流量、淤血指数、脉冲比，结合血清纤维化指标，与超声引导下穿刺活检病理分级结果对比分析。结果门静脉淤血指数、平均流速、透明质酸、Ⅳ型胶原在中、重度组与正常、轻度纤维化组相比，差异有统计学意义（P〈0．05），其中轻度肝纤维化时淤血指数、Ⅳ型胶原较正常组增高，差异有统计学意义（P〈0．05）。结论在慢性肝炎肝纤维化进程中，门静脉血流动力学参数结合血清纤维化指标能快速无创地反映肝纤维化程度，尤其是淤血指数和血清Ⅳ型胶原对慢性肝炎患者肝纤维化的早期诊断有较好的临床价值。

Objective To explore the correlations of portal vein hemodynamics and serum fibrosis markers with liver fibrosis pathological staging in patients with chronic hepatitis. Methods The portal vein hemodynamics of 67 patients with chronic hepatitis were measured, and they were combined with blood serum markers. The results were compared with liver fibrosis pathological staging after puncture under ultrasound guidance. Results Compared with the normal/mild group, the congestion index, mean veloeity（VP）, hyalu- roni（HA） and collagen IV（IV- C） in moderate/serious group had significant difference（ P 〈 0.05）. And the congestion index and IV - C in normal group and mild group had significant difference （ P 〈 0.05）. Conclusion Portal vein hemodynamics combined with blood serum fibrosis markers can reflect the degree of liver fibrosis quickly and non - invasively. It has important clinical value in early diagnosis of chronic hepatitis patients with liver fibrosis.