超声对乙型肝炎肝硬化患者肝静脉压力梯度的评估价值

Ultrasonographic evaluation of hepatic venous pressure gradient in patients with HBV infection and cirrhosis

目的研究分析超声诊断对乙型肝炎肝硬化患者肝静脉压力梯度(hepatic venous pressure gradient,HVPG)的评估价值。方法收集2014年7月—2016年3月间德清县人民医院慢性乙型肝炎肝硬化患者临床资料,共96例乙型肝炎肝硬化患者纳入研究,对所有入组患者进行HVPG测定,根据HVPG水平将入组患者分为高压组(16例)、正常高值组(28例)及正常组(52例)3组。对门静脉、肝右静脉及脾静脉等进行超声检查,收集内径、流速、血流量及充血指数等血管的超声指标,采用方差分析进行组间差异比较,采用Spearman分析HVPG与超声相关指标的相关性,采用Logistic回归分析对HVPG与超声相关指标的相关性进行多因素分析,综合评估超声诊断对乙型肝炎肝硬化患者HVPG的价值。结果不同肝静脉压力梯度水平的患者在肝功能分级、门静脉(PV)内径、PV流速、PV血流量及PV充血指数方面差异具有统计学意义(P<0.05)。Spearman检验显示去除干扰因素后肝功能及门静脉内径和充血指数与HVPG均呈正相关(r=0.524,P<0.001;r=0.614,P<0.001;r=0.458,P<0.001),门静脉流速则与HVPG呈负相关(r=-0.378,P=0.039)。将有统计差异的指标带入Logistic回归分析显示门静脉内径和充血指数与HVPG独立相关(OR=2.397,P=0.020;OR=2.708,P=0.013)。结论超声指标门静脉内径和充血指数与HVPG呈独立正相关,临床可依据二者评估肝静脉压力梯度,为临床诊疗提供依据。

Objective To study the value of ultrasound for evaluation of hepatic vein pressure gradient（HVPG） in patients with HBV infection and cirrhosis. Methods HVPG was measured in 96 patients with HBV infection and cirrhosis in our hospital from July,2014 to March,2016. The patients were divided into three groups according to the results of HVPG： high pressure group （16 cases）, normal high value group（ 28 cases）and normal group（ 52 cases ）. The portal vein, the right hepatic vein and the splenic vein were examined by ultrasonography,and the ultrasonographic indexes such as diameter, flow rate, blood flow and congestion index were collected. The variance analysis was used to compare the differences a- mong groups;the correlation between HVPG and uhrasound-related indexes was analyzed by Spearman and Logistic re- gression analysis. The value of ultrasound diagnosis of HVPG in patients with HBV infection and cirrhosis was evaluated. Results The liver function and portal vein diameter,flow velocity,blood flow and congestion index of the three groups were statistically different（P 〈 0.05 ）. Spearman test showed that liver function and portal vein diameter and congestion index were positively correlated with HVPG （r = 0.524,P 〈 0.001 ;r = 0.614, P 〈 0.001 ;r = 0. 458, P 〈 0.001 ）, flow velocity was negatively correlated with HVPG （r = -0.378, P 〈 0.039）. Logistic regression analysis showed that portal vein diameter and congestion index were independent of HVPG （ OR = 2. 397, P = 0. 020; OR = 2. 708, P = 0. 013 ）. Conclusion There is an independent positive correlation between the portal vein diameter and congestion index and the HVPG, which can be used as the basis for clinical diagnosis and treatment.