彩色多普勒超声评估肝硬化门静脉高压症患者TIPS术后支架功能研究

Assessment of stent function by color Doppler ultrasonography in patients with liver cirrhosis and portal hypertension after transjugular intrahepatic portosystemic shunt

目的探讨彩色多普勒超声评估肝硬化并发门静脉高压症(PH)患者在接受经颈静脉肝内门体分流术(TIPS)术后支架功能的价值。方法2020年1月~2022年12月我院诊治的136例肝硬化患者,经检测肝静脉压力梯度(HVPG)诊断PH,使用彩色多普勒超声测量门静脉血流速度(Vpv)、门静脉内径(Dpv)和门静脉血流量(Qpv),应用受试者工作特征(ROC)曲线评估门静脉血流动力学指标联合诊断肝硬化并发PH的效能。常规行TIPS术,使用数字减影血管造影(DSA)和超声评估支架功能。结果在本组136例肝硬化患者中,经HVPG检测,发现PH者62例(45.6%),对其中52例行TIPS术;肝硬化并发PH患者Vpv为(13.1±2.3)cm/s,显著低于肝硬化非PH者【(15.9±3.2)cm/s,P<0.05】,而Dpv和Qpv分别为(1.3±0.3)cm和(626.8±106.8)mL/min,均显著高于肝硬化非PH者【分别为(1.1±0.2)cm和(499.9±97.2)mL/min,P<0.05】,在TIPS术后,PH组门脉指标恢复,与肝硬化非PH者比,无显著性差异【分别为(16.2±2.5)cm/s、(1.1±0.2)cm和(502.1±99.4)mL/min,P<0.05】;ROC曲线分析显示,Vpv、Dpv和Qpv联合诊断肝硬化并发PH的AUC为0.902(95%CI:0.849~0.955,P<0.05),其敏感度为79.0%,特异度为83.8%;52例接受TIPS治疗患者术后1年随访,经DSA检查发现8例(15.4%)存在支架功能障碍,彩色多普勒超声诊断支架功能障碍与DSA诊断的一致性较强(Kappa=0.680,P<0.05),其敏感度为87.5%,特异度为90.9%,准确率为90.4%。结论彩色多普勒超声检查评估TIPS术后支架功能具有良好的临床应用价值。

Objective The aim of this study was to investigate assessment of stent function by color Doppler ultrasonography in patients with liver cirrhosis(LC)and portal hypertension(PH)after transjugular intrahepatic portosystemic shunt(TIPS).Methods 136 patients with LC were enrolled in our hospital between January 2020 and December 2022,and PH was defined as hepatic venous pressure gradient(HVPG)≥10 mmHg.Color Doppler ultrasonography was used to measure portal vein blood flow velocity(Vpv),portal vein diameter(Dpv)and portal vein blood flow(Qpv),and receiver operating characteristic(ROC)curve was applied to evaluate diagnostic efficacy of portal vein hemodynamic indicator combination in predicting PH.TIPS was performed routinely,and postoperative stent functions was assessed by color Doppler ultrasonography and digital subtraction angiography(DSA).Results Of 136 patients with LC in our series,PH was found in 62 cases(45.6%)based on HVPG measurement and 52 of them received TIPS;Vpv in patients with LC and PH was(13.1±2.3)cm/s,much lower than[(15.9±3.2)cm/s,P<0.05],while Dpv and Qpv were(1.3±0.3)cm and(626.8±106.8)mL/min,both much higher than[(1.1±0.2)cm and(499.9±97.2)mL/min,P<0.05]in cirrhotics without PH,and portal hemodynamic indicators restored to almost normal and showing no significant differences as compared to those in patients without PH[(16.2±2.5)cm/s,(1.1±0.2)cm and(502.1±99.4)mL/min,respectively,P<0.05];ROC analysis showed that the AUC was 0.902(95%CI:0.849-0.955,P<0.05),with sensitivity(Se)of 79.0%,specificity(Sp)of 83.8%,when combination of Vpv,Dpv and Qpv in predicting PH;by end of one year follow-up in 52 patients after TIPS,DSA found stent dysfunction in 8 cases(15.4%),and consistency of ultrasonography was satisfactory(Kappa=0.680,P<0.05),with Se of 87.5%,Sp of 90.9%,and accuracy of 90.4%.Conclusion Color Doppler ultrasound has a good application in identifying stent dysfunction after TIPS in patients with LC and PH.