肝硬化患者肝脏门静脉血流与肝叶萎缩之间关系的研究

The Relation Between Heptic Lobes Atrophy and Portal Vein Flow

目的:探讨肝硬化患者肝脏右叶、左叶体积变化,检测肝硬化患者门静脉血流情况,分析二者之间的关系,以及门静脉血流与肝功能之间关系。方法:本研究纳入54例肝硬化患者和40例正常人,采用超声多普勒方法分析这些受试者的肝脏体积和门静脉主干及左右分支的内径、血流速、流量数据,并通过静脉血检测白蛋白、胆红素、胆碱酯酶水平等评估患者肝功能水平。结果:肝硬化组平均年龄46.3岁,男性32例,其中child A级患者16例,child B级患者27例,child C级患者11例;正常对照组平均年龄41.8岁,男性24例。肝硬化组患者右左肝叶之比明显低于正常对照组(p<0.05),门静脉内径和血流量明显高于正常对照组(p<0.05).随着child分级升高,门静脉血流量也明显升高。肝硬化组门静脉右支血流量明显低于左支血流量(p<0.05);此外肝硬化患者门静脉右支和左支血流量之比明显低于正常人群门静脉右左支之比(p<0.05);而且肝硬化患者门静脉右左支血流量之比与右左肝叶具有明显的相关性与右左肝叶之比具有明显的相关性(r=0.64,p<0.05)。结论:评估肝硬化病人门静脉血流情况,对于判断肝脏病理变化程度,评价治疗效果。

Objective： To evaluate the lobe variety of hepatic cirrhosis, investigate the blood flow of Portal Vein, and analyze the relation between the Portal Vein and hepatic lobes. Methods： 54 patients with hepatic cirrhosis and 40 normal controls were enrolled the study. For all the subjects, the hepatic lobes volume, the portal vein flow, portal vein inner diameter and portal vein blood velocity was evaluated by Doppler ultrasound; and the plasma albumin, bilirubin, acetylcholine esterase were investigated to evaluate the liver function. Results： In the liver cirrhosis group, the mean age of patients was 46.3, and 32 was male; and in these patients, 16 was in Child A, 27 was in Child B, and 11 was in Child C. For the normal controls, the mean age was 41.8, and 24 was male. In the liver cirrhosis, the the ratio of right lobe to left lobe was much lower than the ration in the controls （p〈0.05）, the portal vein inner diameter and blood flow both were significantly higher than the controls, respectively （p〈0.05）. With the Child classification increased, the portal vein blood flow increased, accordingly. In the portal vein blood flow of the liver cirrhosis, the right branch was significant lower than the left branch（p〈0.05）. Besides, the ratio of right-left branch flow of liver cirrhosis was much lower than the ratio in the normal controls（p〈0.05）. In the liver cirrhosis group, the ratio of right-left branch flow was significant correlated with ratio of right-left liver lobe （r=0.64, p〈0.05）. Conclusion： The evaluation of liver portal vein would benefit to the prognosis of liver cirrhosis and treatment effectiveness.