慢性病毒性肝炎门脉血流速度、血流量与血清纤维化指标及肝组织病理改变的关系

Changes in the hemodynamic parameters of the portal vein and serum fibrosis markers in patients with chronic viral hepatitis B

目的阐明慢性肝炎纤维化程度与门脉血流动力学的相关性。方法测定71例慢性乙型肝炎患者门脉血流速度(portal blood velocity, PBFVe)、门脉血流量(portal blood flow, PBFVo)和血清学纤维化指标并观察肝组织的病理改变情况。结果(1)PBFVe与肝纤维化分期关系密切,与血清透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)水平呈负相关,且肝纤维化程度严重者PBFVo明显低于肝纤维化程度轻者,当肝纤维化分期为S4时S1期减慢了29.82%(P<0.01);(2)而PBFVo与肝纤维化分期无关,受肝内炎症活动的影响,与血清Ⅲ型前胶原(PCⅢ)水平呈负相关。结论在慢性肝炎肝纤维化发展过程中,PBFVe与HA、Ⅳ-C相结合能够较好地反映肝纤维化程度;PBFVo与血清PC Ⅲ相结合对判定肝内炎症活动度有意义。

Objective To explore the relationship between portal vein hemodynamics and the severity of fibrosis in patients with chronic hepatitis. Methods Portal vein blood flow velocity(PBFVe)and volume(PBFVo) along with the serum fibrosis markers were examined in 71 patients with chronic viral hepatitis B, and hepatic pathological changes were routinely observed. Results As the hepatitis progressed, the PBFVe decreased in close inverse relation to the degree of liver fibrosis (P<0.01) and the levels of the serum fibrosis markers hyaluronic (HA) and collagen Ⅳ(Ⅳ-C). The PBFVo, however, was not related with the fibrotic status in the patients, but was reduced as the hepatic inflammatory reaction escalated. Conclusion PBFVe is a more sensitive indicator for assessing portal hemodynamics than PBFVo in chronic hepatitis progression, and when combined with serum HA and Ⅳ-C levels, it may demonstrate the severity of hepatic fibrosis. PBFVo together with procollagen Ⅲlevel, however, can be meaningful for deciding the intrahepatic inflammation activity.