彩色多普勒超声检侧不同程度肝纤维化胆道闭锁婴儿肝内血流动力学变化的价值

Value of color Doppler ultrasonography in evaluating the vascular hemodynamic change of liver fibrosis in infants with biliary atresia

目的运用彩色多普勒超声对不同程度肝纤维化胆道闭锁(BA)婴儿肝静脉(HV)、门静脉(PV)及肝固有动脉(HA)的血管内径、各项血流动力学指标进行检测,探讨各项指标诊断BA婴儿肝纤维化的价值。方法选取22例确诊为BA的婴儿作为BA组,其中轻度肝纤维化(S1～S2期)9例,中度肝纤维化(S3期)7例,重度肝纤维化(S4期)6例;选取23例年龄、性别相匹配,排除肝脏、心肺病变的婴儿作为对照组。彩色多普勒超声观察两组婴儿血管频谱的形态,同时测量其肝静脉最大截面直径(HVD)、肝静脉最大流速(HVVmax)、肝静脉最小流速(HVVmin)、门静脉最大截面直径(PVD)、门静脉最大流速(PVVmax)、肝动脉最大截面直径(HAD)、肝动脉最大流速(HAVmax)、肝动脉平均流速(HAVtam)、肝动脉阻力指数(HARI),计算肝静脉衰减指数(HVDI)、肝动脉/门静脉最大流速比率(A/P)。结果 BA组31.8%(7/22)的婴儿HV多普勒波形为HV0型,63.6%(14/22)为HV1型,4.5%(1/22)为HV2型;对照组39.1%(9/23)的婴儿HV多普勒波形为HV0型,47.8%(11/23)为HV1型,13.0%(3/23)为HV2型。BA组与对照组HV频谱形态差异无统计学意义(χ2=1.589,P=0.452)。BA组HV内径为(2.37±0.56)mm,与对照组的(2.58±0.53)mm比较差异无统计学意义(t=1.681,P>0.05);BA组HVDI为(0.79±0.07),较对照组的(0.55±0.20)高,差异有统计学意义(t=2.747,P<0.05)。轻度、中度、重度肝纤维化BA婴儿HV内径分别为(2.52±0.61)、(2.24±0.69)、(2.30±0.30)mm,HVDI分别为(0.75±0.09)、(0.78±0.13)、(0.79±0.05);不同程度肝纤维化BA婴儿HV内径差异无统计学意义(P>0.05),而HVDI差异有统计学意义,且高度肝纤维化组HVDI高于轻度肝纤维化组(χ2=-2.401,P=0.016),差异有统计学意义,其余不同程度肝纤维化BA婴儿之间比较差异无统计学意义(P>0.05)。BA组PV内径为(3.93±0.76)mm,PVVmax为(23.6±8.0)cm/s,与对照组的(3.79±0.66)mm、(23.1±5.5)cm/s比较,差异均无统计学差异(t=0.659、0.685,P>0.05)。轻度、中度、重度肝纤维化BA婴儿PV内径分别为(3.91±0.82)、(4.00±0.62)、(3.88±0.95)mm,PVVmax分别为(22.6±7.1)、(24.2±8.0)、(24.4±10.0)cm/s,不同程度肝纤维化BA婴儿PV内径、PVVmax差异均无统计学意义。BA组HA内径、HAVmax、HAVtam分别为(2.01±0.32)mm、(108.3±49.7)cm/s、(51.6±24.6)cm/s,高于对照组的(1.24±0.38)mm、(47.5±18.4)cm/s、(22.9±8.3)cm/s,差异均有统计学意义(t=8.908、5.181、5.018,P<0.05);BA组HARI为(0.81±0.06),与对照组的(0.77±0.06)比较差异无统计学意义(t=1.910,P>0.05);BA组A/P为(6.76±5.17),低于对照组的(2.26±0.95),差异有统计学意义(t=3.434,P<0.05)。轻度、中度、重度肝纤维化BA婴儿HA内径分别为(2.00±0.82)、(91.84±0.27)、(2.22±0.38)mm,HAVmax分别为(114.4±48.1)、(98.1±16.9)、(111.2±78.1)cm/s,HAVtam分别为(56.4±27.7)、(48.9±16.9)、(47.5±29.9)cm/s,HARI分别为(0.78±0.06)、(0.80±0.06)、(0.86±0.04),A/P分别为(8.55±6.71)、(4.37±1.41)、(6.88±5.82),不同程度肝纤维化BA婴儿HA内径、HAVmax、HAVtam、A/P差异无统计学意义(χ2=0.999、0.602、1.175、1.233,P均>0.05),而HARI差异有统计学意义(χ2=7.891,P=0.019),且重度肝纤维化组HARI高于轻度肝纤维化组,差异有统计学意义(χ2=-2.911,P=0.004),其余不同程度肝纤维化BA婴儿之间比较差异无统计学意义(P>0.05),BA组的HA波形比对照组高、尖。结论在BA婴儿中,HA内径增宽、流速增高对于肝纤维化具有诊断价值,HARI可反映肝纤维化严重程度;HVDI有助于肝纤维化的诊断;PV血流参数对于BA婴儿肝纤维化的诊断意义不大。

Objective To evaluate the value of color Doppler ultrasonography detected hepatic vein,portal vein and hepatic artery hemodynamic features in the diagnosis of liver fibrosis among infants with biliary atresia（BA）.Methods Twenty-two infants diagnosed as BA,were recruited in the study.The infants of BA group were classified into three hepatic fibrosis grades according to the pathology.There were nine infants with low-grade liver fibrosis（S1-S2）,seven with moderate-grade（S3）,six with high-grade（S4）.Twenty-three infants（age and gender matching）without known hepatic,cardiac,or pulmonary disease were set as control.The diameters of hepatic vein,portal vein and hepatic artery were measured,the flow patterns were observed by color Doppler ultrasonography,the hemodynamic parameters were measured.The parameters of the hepatic vein included hepatic vein diameter（HVD）,the maximum velocity（HVVmax）and the minimum velocity（HVVmin）.The portal vein parameters included portal vein diameter（PVD）and the maximum velocity（PVVmax）.The hepatic artery parameters included hepatic artery diameter（HAD）,the maximum velocity（HAVmax）,the time average velocity（HAVtam）and the resistance index（HARI）.Hepatic vein damping index（HVDI）,the rate of the maximum velocity of hepatic artery and portal vein（A/P）were also calculated.Results In the BA group,31.8%（7/22）of the infants presented as HV0 hepatic venous flow pattern,63.6%（14/22）as HV1 pattern,4.5%（1/22）as HV2 pattern.In the control group,39.1%（9/23）showed as HV0 pattern,47.8%（11/23）as HV1 pattern,13.0%（3/23）as HV2 pattern.The difference of hepatic venous flow pattern between the BA group and the control was not significant（χ2=1.589,P=0.452）.The HVD was（2.37±0.56）mm in BA group,（2.58±0.53）mm in control group,with no significant difference（t=1.681,P=0.108）.In the BA group,The HVDI（0.79±0.07）was significantly higher than that of the control（0.55±0.20）（t=2.747,P=0.023）.The HVD in the low-,moderate-and high-grade fibrosis cases were（2.52±0.61）,（2.24±0.69）and（2.30±0.30）mm.The HVDI were（0.75±0.09）,（0.78±0.13）,（0.79±0.05）respectively.The difference of HVD in each fibrosis case was not significant（P0.05）.While the HVDI in each fibrosis case was different significantly,the HVDI in the high-grade fibrosis cases was significantly higher than that of the low-grade fibrosis cases（χ2=-2.401,P=0.016）.The PVD and PVVmax between the BA group[（3.93±0.76）mm,（23.6±8.0）cm/s]and the control group[（3.79±0.66）mm,（23.1±5.5）cm/s]were not significantly different（t=0.659,0.685,both P0.05）.The PVD in the low-,moderate-and high-grade fibrosis cases was（3.91±0.82）,（4.00±0.62）and（3.88±0.95） mm,respectively,the PVVmax were（22.6±7.1）,（24.2±8.0） and（24.4±10.0）cm/s,respectively,which had no significant difference.the HAD in BA group [（2.01±0.32）mm] was significantly larger（t=8.908,P=0.000）than that in control group[（1.24±0.38）mm].HAVmax in the BA group [108.3±49.7]cm/s] was significant higher（t=5.181,P=0.000）than that in the control group[（47.5±18.4）cm/s].The HAVtam was（51.6±24.6）cm/s in the BA group,and（22.9±8.3）cm/s in the control,the difference was significant（t=5.018,P=0.000）.The RI between the BA（0.81±0.06）and control group（0.77±0.06）was not significantly different（t=1.910,P=0.070）.The A/P of BA group（6.76±5.17）was significantly higher（t=3.434,P=0.002）than that of the control（2.26±0.95）.The differences of the HAD,HAVmax,HAVtam in the fibrosis groups were not significant（χ2=0.999,0.602,1.175,1.233,all P0.05）,while the HARI was significantly different（χ2=7.891,P=0.019）.The HARI in the high-grade fibrosis group（0.86±0.04） was significantly higher（χ2=-2.911,P=0.004）than low-grade fibrosis groups（0.78±0.06）.The HA spectrum of the BA group was higher and sharper that that in the control.Conclusions In infants with biliary atresia,the enlarged diameter and enhanced maximum velocity of hepatic artery is valuable for the diagnosis of liver fibrosis,the HARI is helpful for predicting the degree of liver fibrosis.The HVDI is valuable for the diagnosis of liver fibrosis in the infants with biliary atresia,while the color Doppler characteristics of the portal vein were not as valuable for the diagnosis.