彩色多普勒超声对失代偿性肝硬化患者自体骨髓干细胞移植治疗前后的对比观察

Comparative study of decompensated cirrhosis before and after autologous bone marrow stem cell transplantation by color Doppler ultrasound

目的探讨彩色多普勒超声评价自体骨髓干细胞移植治疗乙型肝炎肝硬化失代偿期患者疗效的应用价值。方法经肝动脉行自体骨髓干细胞移植治疗的乙型肝炎肝硬化失代偿期患者43例,分别于治疗前1～3d内,治疗后第3个月和6个月观察患者腹水情况,肝脏形态和内部回声变化,以及门静脉系统血流颜色变化,并用超声测量肝脏门静脉内径和门静脉血流速度;脾脏厚径、脾静脉内径和脾静脉血流速度。结果①与术前比较,自体骨髓干细胞移植术后第3个月腹水量减少者35例,肝脏形态和内部回声无明显变化,门静脉和脾静脉血流颜色变明亮,门静脉血流速度增快(P<0.01);脾脏缩小,脾静脉内径变窄,以及脾静脉血流速度增快(P<0.05)。②与术前比较,术后第6个月腹水量减少者41例,且其中15例完全消失,门静脉和脾静脉血流颜色明亮,肝脏形态和内部回声未见明显变化,门静脉内径变细(P<0.05),门静脉血流速度明显增快(P<0.01);脾脏明显缩小,脾静脉内径变窄,脾静脉血流速度明显增快(P<0.01)。术后3个月与6个月比较,其门静脉血流速度,脾脏厚径减小,脾静脉内径变小,脾脏静脉血流速度增快,差异均有统计学意义(均P<0.05)。结论彩色多普勒超声通过观察门静脉系统血流颜色及血流动力学变化,对临床评价自体骨髓干细胞移植治疗乙型肝炎肝硬化失代偿期患者的效果有重要的指导意义。

Objective To explore the applicaton value of color Doppler ultrasound in evaluating the therapeutic effect of autologous bone marrow stem cell （BMSCs）transplantationon patients with hepatitis B decompensated cirrhosis. Methods Forty- three patients with hepatitis B deeompensated cirrhosis were enrolled in this study, their ascites, hepatic shape, parenchyma echo changes and portal blood flow changes were observed in 1 - 3 d before treatment, the third month and the sixth month after treatment, the portal vein diamete, portal blood flow mean velocity, spleen size, splenic vein diameter and splenic vein blood flow velocity were measured by ultrasound. Results Compared with pre - operation, aseites was reduced in 35 patients 3 months after treated by BMSCs transplantation with no significant changes in liver shape and parenchyma echo, while the color of portal and splenic vein blood flow became brighter, portal venous velocity was increased （ P 〈 0.01 ）. Spleen size and spleen vein diameter were decreased, splenic vein velocity was increased （ P 〈 0.05 ）. Compared with pre - operation, ascites was reduced in 41 patients and disappeared in 15 patients 6 months after treatment with no significant changes in liver shape and parenchyma echo, while the color of portal and splenic vein blood flow became brighter, portal vein diameter was decreased （P 〈0.05）, portal venous velocity was increased （P 〈0.01 ）. Spleen size and spleen vein diameter were decreased, splenic vein velocity was increased（ P 〈 0.01 ）. Compared with 3 months after treatment, the portal venous velocity was increased 6 months after treatment. Spleen size and spleen vein diameter were decreased, splenic vein velocity was increased, there was significant difference（ P 〈 0.05 ）. Conclusion Color Doppler ultrasound has important guiding significance in evaluating the clinical efficacy of hepatitis B decompensated cirrhosis after BMSCs transplantation by observing portal venous system＇ s hemodynamics.