彩色多普勒超声对亚临床肝肾综合征的诊断价值

Value of Color Doppler Ultrasonography in the Diagnosis of Preclinical Hepatorenal Syndrome

目的探讨彩色多普勒超声检查在临床诊断亚临床肝肾综合征中的应用价值。方法应用彩色多普勒超声检测肾功能正常的肝硬化代偿期患者(30例)和肝硬化失代偿期患者(30例)的主肾动脉内径(D)及肾脏血流动力学参数〔收缩期峰值流速(PSV)、舒张末期流速(EDV)及阻力指数(RI)〕,并与健康者(对照组,30例)对照。结果肝硬化失代偿组患者主肾动脉D〔(0.39±0.06)cm〕较对照组〔(0.56±0.05)cm〕及肝硬化代偿组〔(0.53±0.04)cm〕显著减小,差异有统计学意义(P<0.01);肝硬化失代偿组患者肾动脉EDV〔(16.0±5.4)cm/s〕亦显著低于对照组〔(29.2±6.0)cm/s〕及肝硬化代偿组〔(28.6±5.9)cm/s〕,差异有统计学意义(P<0.01);肝硬化失代偿组患者肾动脉RI(0.73±0.06)显著高于对照组(0.60±0.04)及肝硬化代偿组(0.61±0.05),差异有统计学意义(P<0.01)。3组肾动脉PSV间差异无统计学意义(P>0.05)。结论彩色多普勒超声能敏感、客观地评价肾功能正常的肝硬化患者肾脏血流动力学紊乱情况,进而了解肾小球滤过率和肾血流状态,对亚临床肝肾综合征的早期诊断有重要价值。

Objective To evaluate the value of color Doppler ultrasonography used in the diagnosis of preclinical hepatorenal syndrome （HRS）.Methods Color Doppler ultrasonography was applied to detect the inner diameter of renal artery and the renal hemodynamic parameters including peak systolic velocity （PSV）,end diastolic velocity （EDV） and resistive index（RI） in hepatic cirrhosis patients with normal renal function who were at compensation stage （n=30）and at decompensation stage （n=30）,and the results were compared with those of the control group （n=30）.Results The inner diameter of renal artery in the decompensation group [（0.39±0.06）cm]was significantly decreased than those in the control group[（0.56±0.05）cm] and the compensation group[（0.53±0.04）cm]（P〈0.01）;the value of EDV[（16.0±5.4）cm/s]was also significantly lower than those in the control group[（29.2±6.0）cm/s] and the compensation group[（28.6±5.9）cm/s] （P〈0.01）.But the value of RI（0.73±0.06） was significantly higher than those in the control group （0.60±0.04） and the compensation group （0.61±0.05） （P〈0.01）.However,no significant difference was found in PSV among the three groups（P〉0.05）.Conclusion Color Doppler ultrasonography can objectively and sensitively evaluate the disturbance of renal hemodynamics of hepatic cirrhosis patients with normal renal function,and it is helpful in estimating the glomerular filtration rate and the status of renal hemodynamics,and it might be of great importance for an early diagnosis of preclinical hepatorenal syndrome.