CEUS评价失代偿期肝硬化门静脉高压及血流动力学参数的价值

The value of CEUS in evaluating the portal hypertension and hemodynamic parameters of decompensated cirrhosis

目的:探讨对比增强超声(CEUS)评价失代偿期肝硬化患者门静脉高压和门静脉血流动力学参数的变化及其意义。方法:选取在医院确诊的70例失代偿期肝硬化患者纳入病例组,另选70名健康志愿者作为健康对照组,采用CEUS检测并观察比较两组的门静脉内径(Dpv)、门静脉平均血流速度(PVV)、肝动脉阻力系数(HARI)、脾动脉阻力指数(SPARI)、肝动脉内造影剂到达时间(HAAT)、肝静脉内造影剂到达时间(HVAT)、HAAT与HVAT之差值(HA-VVT)、肝实质达峰时间(Tpeak)、门静脉灌注时间(Tp)、肝动脉-门静脉灌注强度比(Ia/Ip)、肝动脉-肝实质峰值强度比(Ia/Ipeak)和门静脉高压。结果:病例组的Dpv、SPARI显著高于健康对照组,其差异有统计学意义(t=19.525,t=12.798;P<0.05),PVV、HARI显著低于健康对照组,其差异有统计学意义(t=-24.428,t=10.967;P<0.05);HAAT、HVPG显著高于对照组,其差异有统计学意义(t=-3.325,t=14.029;P<0.05),病例组的HVAT、HA-VVT I显著低于对照组,其差异有统计学意义(t=-15.187,t=-21.367;P<0.05);病例组的Ia/Ip、Tp显著高于对照组,其差异有统计学意义(t=23.397,t=6.972;P<0.05),Tpeak、Ia/Ipeak显著低于对照组,其差异有统计学意义(t=-11.379,t=-21.145;P<0.05);失代偿期肝硬化患者的HVAT、HA-VVTI与HVPG呈显著的负相关关系(r=0.611、r=-0.578;P<0.05),HAAT与PHT无显著的相关关系(r=0.271,P>0.05)。结论:采用CEUS评价失代偿期肝硬化患者门静脉高压症(PHT)病情、门静脉血流动力学具有较重要的临床价值,同时具有无创的优势。

Objective: To investigate that contrast-enhanced ultrasound (CEUS) evaluated the changes of portal hypertension and portal hemodynamic parameters of patients with decompensated cirrhosis and its significance. Methods: Seventy patients with decompensated cirrhosis who were diagnosed in hospital were enrolled in the case group, and another 70 healthy volunteers were selected in the healthy control group. CEUS was adopted to detect, observe and compare the portal vein diameter (Dpv), portal vein mean blood flow velocity (PVV), hepatic artery resistance index (HARI), splenic artery resistance index (SPARI), intra-hepatic artery contrast agent arrival time (HAAT), hepatic vein contrast agent arrival time (HVAT), difference of HAAT and HVAT (HA-VVT), liver parenchyma peak time (Tpeak), portal vein perfusion time (Tp), the ratio of perfusion intensity between hepatic artery and portal vein (Ia/Ip), the ratio of peak value intensity between hepatic artery and liver parenchyma peak (Ia/Ipeak) and portal hypertension (PHT) of the two groups. Results: The Dpv and SPARI in case group were significantly higher than those in healthy control group (t=19.525, t=12.798, P<0.05), and the PVV and HARI of case group were significantly lower than those of healthy control group (t=-24.428, t=10.967, P<0.05), respectively. And the HAAT and HVPG in case group were significantly higher than those in control group (t=-3.325, t=14.029, P<0.05).The HVAT and HA-VVT I in case group were significantly lower than those in control group (t=-15.187, t=-21.367, P<0.05). The Ia/Ip and Tp in case group were significantly higher than those in control group (t=23.397, t=6.972, P<0.05). And the Tpeak and Ia/ Ipeak of case group were significantly lower than those of control group (t=-11.379, t=-21.145, P<0.05). There was a significant negative correlation between HVAT, HA-VVTI and HVPG of patients with decompensated cirrhosis (r=0.611, r=-0.578, P<0.05). There was no significant correlation between HAAT and PHT (r=0.271, P>0.05). Conclusion: CEUS that is used to evaluate the situation of portal hypertension and hemodynamics of portal vein of patients with decompensated cirrhosis has more important clinical value and its other advantages is non-invasive.