彩色多普勒超声辨别肝硬化患者中医证型的价值研究

Study on the Value of Color Doppler Ultrasound in Identifying Chinese Medicine Syndrome Types of Patients with the Liver Cirrhosis

目的:探讨彩色多普勒超声辨别肝硬化患者中医证型的应用价值。方法:选取182例肝硬化患者行彩色多普勒超声检查,观察患者肝表面形态、实质回声,检测肝右叶最大斜径及前后径、肝左叶上下径及前后径、腹水深度,检测门静脉、脾静脉主干内径及平均血流速度。结果:肝气郁结型、水湿内阻型、湿热内蕴型肝硬化肝左叶上下径均大于瘀血阻络型(P<0.05)。肝气郁结型、水湿内阻型、湿热内蕴型肝硬化出现被膜锯齿状、弥漫回声增高比率低于瘀血阻络型、脾肾阳虚型、肝肾阴虚型(P<0.05)。各证型肝硬化腹水深度及盆腔腹水深度比较,差异均无统计学意义(P>0.05)。瘀血阻络型、脾肾阳虚型、肝肾阴虚型肝硬化门静脉主干内径大于湿热内蕴型(P<0.05),肝气郁结型肝硬化门静脉平均血流速度大于瘀血阻络型(P<0.05)。结论:肝气郁结型、水湿内阻型、湿热内藴型肝硬化患者超声表现少有被膜锯齿状、弥漫回声增高的特点,瘀血阻络型、脾肾阳虚型、肝肾阴虚型肝硬化患者肝硬化门静脉主干内径较大,肝气郁结型肝硬化患者门静脉平均血流速度较大。肝左叶上下径、表面形态、门静脉内径及血流速度可为肝硬化的中医辨证分型提供一定的指导。

Objective: To discuss the application value of color Doppler ultrasound in identifying Chinese medicine syndrome types of patients with the liver cirrhosis. Methods: A total of 182 cases of patients with the liver cirrhosis undergoing color Doppler ultrasonography were selected. The liver surface morphology and echoes were observed. The maximal oblique diameter and anteroposterior diameter of the right lobe of the liver, the maximal vertical diameter and anteroposterior diameter of the left lobe of the liver,ascites depth,and the inner diameters of main portal vein and main splenic vein,as well as the mean blood flow velocity were detected. Results:The vertical diameter of the left lobe of the liver the liver-qi depression type,internal obstruction of water-dampness type,and internal retention of dampness-heat type was significantly larger than that in static blood obstructing the collaterals type(P<0.05). The rates of serrated capsule occurrence and heightening diffuse echo in patients with the liver cirrhosis of the liver-qi depression type, internal obstruction of water-dampness type,and internal retention of dampness-heat type were significantly lower than those of static blood obstructing the collaterals type,the spleen-kidney yang deficiency type,and the liver-kidney yin deficiency type(P<0.05). When compared ascites depth and pelvic ascites depth of patients with the liver cirrhosis among various syndrome types,there was no significant difference(P>0.05). The inner diameter of main portal vein in patients with the liver cirrhosis of static blood obstructing the collaterals type,spleen-kidney yang deficiency type,and liver-kidney yin deficiency type was significantly larger than that of internal retention of dampness-heat type(P<0.05). The mean blood flow velocity of portal vein in patients with the liver cirrhosis of liver-qi depression type was significantly larger than that of static blood obstructing the collaterals type(P<0.05). Conclusion: The ultrasonic manifestations in patients with the liver cirrhosis of the liver-qi depression type, internal obstruction of water-dampness type, and internal retention of dampness-heat type seldom include serrated capsule and heightening diffuse echo. In patients with the liver cirrhosis of static blood obstructing the collaterals type,spleen-kidney yang deficiency type,and liver-kidney yin deficiency type,the inner diameter of main portal vein is larger. In patients with the liver cirrhosis of the liver-qi depression type,the mean blood flow velocity of portal vein is larger. The vertical diameter of the left lobe of the liver,surface morphology,the inner diameter of portal vein and blood flow velocity can provide certain guidance for the typing of Chinese medicine syndromes of liver cirrhosis.