超声血流参数对肝硬化门脉高压症的诊断价值

Diagnostic value of hemodynamic parameters measured by ultrasound in patients with hepatic cirrhosis and portal hypertension

目的:研究超声参数对门脉高压的诊断价值.方法:以经颈静脉门体静脉分流术(TIPS)中导管测量的门体静脉压差≥6.8cmH2O为诊断PHT(PHT)的金标准,将25例肝硬化患者分为试验组(18例)和对照组(7例),利用随机双盲法研究两组的超声血流参数,使用单因素方差分析组间差异,利用受试者工作曲线ROC曲线分析诊断门脉高压超声参数的最佳指标.结果:发现试验组PV、脾静脉、肠系膜上静脉内径大于对照组,下腔静脉内径低于对照组.PV流速低于对照组,而脾静脉及肠系膜上静脉的流量高于对照组.根据ROC曲线确定的最佳超声参数是PV内径,以门脉内径≥1.45cm为诊断标准,其诊断门脉高压的敏感度为94.4%、特异度为57.1%,准确率为0.84,Youden指数为0.515.结论:超声对肝硬化门脉高压定性诊断敏感性及准确率较高.

AIM： To compare ultrasonic hemodynamic parameters with portal vein pressure measured via a catheter placed in transjugular intrahepatic portosystemic shunt （TIPS） to search the optimal ultrasonic parameters. METHODS： Twenty-five patients with hepatic cirrhosis （HC） were observed in this randomized double-blind trial. These patients were divided into experimental group （PVPG ≥ 6.8 cmH2O, n = 18） and control group （PVPG 6.8 cmH2O, n = 7）. Intragroup differences were compared using single factor variance analysis. The ROC curve is used to evaluate the diagnostic value of ultrasonic parameters. RESULTS： The diameters of the portal vein （PV）, splenic vein （SV） and superior mesenteric vein（SMV） were higher and that of the inferior vena cava （IVC） was lower in the experimental group than in the control group. PV flow velocity was lower and the blood flow volumes of the SV and SMV were higher in the experimental group than in the control group. ROC curve analysis showed that PV diameter is the optimum parameter for qualitative diagnosis of portal hypertension, with a sensitivity of 94.4%, a specificity of 57.1%, an accuracy of 84%, and a Youden index of 0.515. CONCLUSION： Ultrasound has a high sensitivity and accuracy in qualitative diagnosis of portal hypertension.