超声造影+超声门静脉血流动力学联合血清指标检测诊断失代偿期肝硬化患者门静脉高压的价值

Value of contrast-enhanced ultrasound combined with portal hemodynamics and serum markers in diagnosis of decompensated cirrhosis

目的探讨超声造影+超声门静脉血流动力学联合血清指标检测对失代偿期肝硬化患者门静脉高压的诊断价值。方法选择焦作市第二人民医院于2017年12月至2019年12月收治的80例失代偿期肝硬化患者作为研究组,另选择同期收治的80例代偿期肝硬化患者作为代偿期组,60例健康体检者作为对照组。所有研究对象均行超声造影+超声门静脉血流动力学检查,并进行血清标志物检测。比较三组血流动力学指数、肝静脉内造影剂到达时间(HVAT)、肝动脉内造影剂到达时间(HAAT)、肝动-静脉渡越时间(HA-VTT)及血清指标变化情况;分析超声造影+超声门静脉血流动力学联合血清指标的诊断效能。结果研究组门静脉内径(Dpv)、门脉高压指数(PHI)、肝动脉阻力指数(HAPI)高于代偿期组和对照组,而门静脉血流速度(PVV)低于代偿期组和对照组(P<0.05);代偿期组Dpv、PHI、HARI高于对照组,而PVV低于对照组(P<0.05)。研究组HVAT、HA-VTT低于代偿期组和对照组,而HAAT高于代偿期组和对照组(P<0.05);代偿期组HVAT、HA-VTT低于对照组,而HAAT高于对照组(P<0.05)。研究组血清白蛋白(Alb)低于代偿期组和对照组,而总胆红素(TBiL)凝血酶原时间(PT)高于代偿期组和对照组(P<0.05);代偿期组血清Alb低于对照组,而TBiL和PT高于对照组(P<0.05)。超声造影+超声门静脉血流动力学联合血清指标的诊断灵敏度(84.92%)和特异度(90.12%)高于超声造影+超声门静脉血流动力学(68.29%,59.63%)与血清指标(35.41%,46.81%)。结论超声造影+超声门静脉血流动力学联合血清指标对失代偿期肝硬化患者门静脉高压具有较高的诊断价值。

Objective To investigate the value of contrast-enhanced ultrasound combined with portal hemodynamics and serum markers in diagnosis of decompensated cirrhosis.Methods A total of 80 patients with decompensated cirrhosis admitted to the Second People’s Hospital of Jiaozuo from December 2017 to December 2019 were selected as the study group.Moreover,80 patients with compensated cirrhosis were selected as the compensatory group in the same period;and 60 healthy people were selected as the control group.All subjects underwent contrast-enhanced ultrasound,ultrasound portal hemodynamics detection and serum markers detection.The hemodynamic indexes,hepatic vein arriving time(HVAT),hepatic artery arriving time(HAAT),hepatic artery-vein transit time(HA-VTT)and serum indexes were compared among the three groups.The diagnostic efficacy of contrast-enhanced ultrasound combine with portal hemodynamics and serum parameters was analyzed.Results Diameter of portal vein(Dpv),portal hypertension index(PHI)and hepatic artery resistance index(HARI)in the study group were higher than those in the compensatory group and the control group,while protal vein velocity(PVV)was lower than that in the compensatory group and control group(P<0.05).Dpv,PHI and HARI in the compensatory group were higher than those in the control group,while PVV was lower than that in the control group(P<0.05).HVAT and HA-VTT in the study group were lower than that in the compensatory group and the control group,while HAAT was higher than that in the compensatory group and the control group(P<0.05).HVAT and HA-VTT in the compensatory group were lower than those in the control group,while HAAT was higher than that in the control group(P<0.05).Serum albumin(Alb)level in the study group was lower than that in the compensatory group and control group,while levels of total bilirubin(TBiL)and prothrombin time(PT)were higher than those in the compensatory group and control group(P<0.05);serum Alb level in the compensatory group was lower than that in the control group,while levels of TBiL and PT were higher than those in the control group(P<0.05).The diagnostic sensitivity and specificity of contrast-enhanced ultrasound combined with portal hemodynamics and serum markers(84.92%,90.12%)were higher than those of contrast-enhanced ultrasound combined with portal hemodynamics(68.29%,59.63%)and only serum markers detection(35.41%,46.81%).Conclusions Contrast enhanced ultrasonography combined with portal hemodynamics and serum markers has high diagnostic value for portal hypertension in patients with decompensated cirrhosis.