失代偿期肝硬化患者肝静脉压力梯度与超声造影参数的相关性分析

Correlation analysis of hepatic vein pressure gradient and contrast-enhanced ultrasonography parameters in patients with decompensated liver cirrhosis

目的考察失代偿期肝硬化患者的肝静脉压力梯度（HVPG）与超声造影参数的相关性,旨在探求无创评估失代偿期肝硬化患者门静脉压力的新方法。方法选取2014年10月~2015年10月在我院消化科进行诊治的失代偿期肝硬化患者89例。对所有患者行HVPG测定,并采集患者的超声造影动态图像,选择肝静脉、肝动脉、门静脉这3个感兴趣区进行分析,计算门静脉-肝静脉渡越时间（PV-HVTT）和肝动脉-肝静脉渡越时间（HA-HVTT）。将得到的超声造影参数与测得的HVPG进行Pearson相关性分析,并利用ROC曲线分析。结果肝静脉显影时间、门静脉-肝静脉渡越时间和肝动脉-肝静脉渡越时间与HVPG有相关性,呈负相关。ROC曲线分析结果显示：PV-HVTT≤2s（1.82）预测失代偿期肝硬化患者的HVPG≥12mm Hg的ROC曲线下面积为0.79,敏感性为0.64,特异性为0.81。而当PV-HVTT≤3s（1.73）时可预测HVPG≥16mm Hg的ROC曲线下面积为0.84,敏感性为0.77,特异性为0.78。结论超声造影是一种无创、安全、无辐射的诊断手段,门静脉-肝静脉渡越时间（PV-HVTT）与HVPG有相关性,可用于预测失代偿期肝硬化患者食管胃静脉曲张出血。

Objective To investigate the correlation of hepatic vein pressure gradient and contrast-enhanced ultrasonography parameters in patients, and to explore a new noninvasive evaluation in patients with decompensated liver cirrhosis portal vein pressure. Methods 89 cases of decompensated liver cirrhosis patients in our hospital gastroenterology dept from October 2014 to October 2015 were selected as object of study.All patients HVPG determination and collected the dynamic of contrast-enhanced ultrasound.Three areas of interest of hepatic vein,hepatic artery, portal vein were selected to analyze,and PV-HVTT（Portal vein to hepatic vein transit time）and HA-HVTT（Hepatic artery to hepatic vein transit time） were calculated.Ultrasonic imaging parameters and HVPG were analyzed the correlation by Pearson and ROC curve. Results There were negative correlations between HVAT, PVHVTT, HA-HVTT and HVPG.ROC curve analysis results showed： PV-HVTT ≤ 2s could predict the sensibility was 0.64,the specificity was 0.81 of HVPG ≥ 12 mm Hg of decompensated period liver cirrhosis patients,nevertheless PVHVTT ≤ 3s could predict the sensibility was 0.77 and the specificity was 0.78 of HVPG ≥ 16 mm Hg. Conclusion Contrast-enhanced ultrasonography is a noninvasive,safe,radiationless means of diagnosis. PV-HVTT and HVPG have relativity.It can be used to predict patients with decompensated cirrhosis esophageal gastric varices bleeding.