彩色多普勒超声在门脉高压症中的应用价值

THE PRACTICAL VALUE OF COLOR DOPPLER FLOW IMAGING IN PATIENTS WITH PORTAL HYPERTENSION

探讨彩色多普勒超声对判断或预测食管胃底静脉曲张破裂出血的价值。方法 :应用彩色多普勒超声检查 43例门脉高压症和 40例对照组的门脉系统血流动力学参数 ,并计算脾静脉血流量 /门静脉血流量 (QSV/ QPV)比值。结果 :门脉高压时脾门静脉增宽 ,血流量增大 ,但血流速度较对照组显著降低 (P <0 .0 1或 P <0 .0 5 ) ;以上参数在门脉高压伴食管胃底静脉曲张破裂出血组与无出血组比较无显著差异 (P >0 .0 5 ) ;门脉高压组 QSV/ QPV比值显著高于对照组 (0 .48± 0 .10与0 .2 7± 0 .0 8,P <0 .0 1) ;且伴食管胃底静脉曲张破裂出血组较无出血组显著增高 (0 .5 2± 0 .11与 0 .44± 0 .10 ,P <0 .0 5 ) ;以QSV/ QPV比值大于或等于 0 .43为界值 ,诊断食管胃底静脉曲张破裂出血的敏感度及特异度分别为 76 .9%与 83.3%。结论 :彩色多普勒超声对判断门脉系统血流动力学有重要价值 ,测定 QSV/ QPV比值是一种方便且无侵入性的判断与预测门脉高压时食管胃底静脉曲张破裂出血的方法。

Objective:To investigate the usefulness of color Doppler flow imaging (CDFI) in the assessment of the risk of bleeding in patients with gastroesophageal varices Methods:43 patients with portal hypertension (30 without previous gastroesophageal varice bleeding and 13 with first or recurrent bleeding) and 40 normal controls were included in the study A variety of hemodynamic parameters including the vein diameter,the flow velocity,the flow volume of the splenic and the portal vein(QSV and QPV),and the ratios of QSV/QPV were visualized or measured Results:The results showed that the vein diameter and the flow volume of splenic and portal vein increased significantly,but the flow velocity decreased significantly as compared with normal controls The ratio of QSV/QPV in patients with portal hypertension was significantly higher than that of normal controls (0 48±0 10 vs 0 27±0 08,P<0 01) Furthermore,the ratio of QSV/QPV in bleeding group was significantly higher than that of non bleeding group(0 52±0 11 vs 0 44±0 10,P<0 05) By assuming the cut off value as 0 43(normal controls x+2s),we obtained the sensitivity and the specificity for the diagnosis of varice bleeding of 76 9% and 83 3% respectively Conclusions:It is suggested that CDFI is valuable in the judgement of the hemodynamic changes in portal hypertension,and the measurement of the ratio of QSV/QPV is a noninvasive and convenient method to predict the risk of gastroesophageal varice bleeding in patients with portal hypertension