腹腔动脉、肠系膜上、下动脉彩色多普勒超声对克罗恩病活动期的诊断价值

背景:彩色多普勒超声作为一种非侵入性、无辐射的成像手段,在克罗恩病(CD)的临床诊断和监测中发挥越来越重要的作用。目的:探讨腹腔动脉(CA)、肠系膜上动脉(SMA)、肠系膜下动脉(IMA)彩色多普勒超声对CD活动期的诊断价值。方法:纳入2010年1月～2012年12月南京大学医学院附属鼓楼医院消化科收治的CD活动期患者29例,选取32例同时期因非肠道病变就诊的患者作为对照组。应用彩色多普勒超声对患者CA、SMA、IMA进行检测,记录管径、收缩期峰值流速(PSV)、舒张末期流速(EDV)以及阻力指数(RI)。结果:CD组CA的PSV值和RI值较对照组显著升高(P=0.0001),两组管径和EDV值差异无统计学意义(P=0.16;P=0.47)。CD组SMA的EDV值较对照组显著升高(P=0.03),两组管径、PSV、RI值差异无统计学意义(P=0.17;P=0.09;P=0.05)。CD组IMA的EDV值较对照组显著降低(P=0.04),两组管径、PSV、RI值差异无统计学意义(P=0.07;P=0.34;P=0.19)。结论:CD活动期CA、SMA和IMA的血流动力学参数发生显著改变,这对诊断CD和评估其活动性具有一定价值。     

肝硬化患者肠系膜上动脉血流动力学的变化与腹水形成的关系

采用彩色多普勒超声对40例健康者（对照组）及80例有（或）无腹水肝硬化患者（肝硬化组）进行肠系膜上动脉（SMA）血流动力学测定。结果显示：肝硬化患者SMA内径（D）、血流速度（v)、血流量（Q）均较对照组显著升高,有腹水者较无腹水者高、SMA脉动指数（SMA－PI）和阻力指数（SMA－RI）均显著降低（P＜0．01）,尤以SMPI降低明显。肝硬化腹水组治疗前后上述各指标均无明显差异（P＞0．05）。提示肝硬化患者SMA处于高动力循环状态,此为肝硬化腹水形成的原因之一。     

慢性肠系膜动脉阻塞性疾病

肠系膜动脉包括腹腔动脉（celiac artery, CA）、肠系膜上动脉（superior mesenteric artery, SMA）、肠系膜下动脉（inferior mesenteric artery, IMA）。慢性肠系膜动脉阻塞以高龄患者多见,女性占60%,70%有吸烟病史。尸检发现,＞60岁患者CA狭窄发生率为50%、SMA为30%、IMA为20％。     

慢性肠系膜动脉阻塞性疾病的介入治疗

肠系膜动脉包括腹腔动脉（celiac artery，CA）、肠系膜上动脉（superior mesenteric artery，SMA）、肠系膜下动脉（inferior mesenteric artery，IMA）。肠系膜动脉阻塞为临床急症之一、误诊率较高，一旦发生肠梗死后，病死率为50％～80％，即使肠梗死能够得到手术治疗，多数患者术后残留肠管过短、不能保证足够的营养物质吸收，因此需要终生给予胃肠外营养。根据临床表现，肠系膜缺血分为急性和慢性，     

彩色多普勒超声对年龄相关性黄斑变性患者眼血流动力学的评价

目的探讨眼动脉（OA）、视网膜中央动脉（CRA）和睫状后动脉（PCA）血流动力学的变化与年龄相关性黄斑变性（AMD）的关系。方法用彩色多普勒超声检测AMD患者OA、CRA、PCA的血流动力学指标,并对其频谱血流资料进行分析。结果收缩期峰值血流速度均降低,除OA组与正常组比较无统计学差异（P〉0.05）,其余各组间比较有统计学差异（P均〈0.05）;舒张末期最低血流速度下降、阻力指数和搏动指数升高,各组间比较均有统计学差异（P均〈0.05）;随着AMD病情加重,各血流参数也发生相应的变化,PCA较CRA更明显。结论AMD患者眼部缺血导致CRA和PCA的血流动力学参数发生相应的改变;彩色多普勒超声检查为AMD的发病机制研究、病情分析和预后评估提供了客观的检测手段。     

多排螺旋CT平扫对肠系膜上动脉压迫综合征的诊断价值

目的 探讨多排螺旋CT(MDCT)平扫对肠系膜上动脉压迫综合征（SMAS）的诊断价值。方法 收集22例SMAS患者（观察组）和19例非SMAS患者（对照组）的多排螺旋CT平扫资料，采用Spearman等级相关分析法分析肠系膜上动脉（SMA）可见性与年龄的相关性。采用Fisher确切概率法检验两组SMA弯曲类型、十二指肠水平段近端扩张、充气所占比例差异。测量观察组、对照组的主动脉肠系膜上动脉夹角（AMA）、主动脉肠系膜上动脉距离（AMD），采用t检验分析差异，采用受试者工作特征（ROC）曲线测定AMA、ASD诊断SMAS的阈值。结果 观察组SMA可见性与年龄呈正相关（r=0.592,P<0.01）。观察组十二指肠水平段近端扩张比例高于对照组，两组SMA弯曲类型占比差异无统计学意义（P>0.05）。观察组、对照组AMA分别为19.5°±11.4°、37.2°±25.2°，两组比较差异有统计学意义（P<0.05）。通过AMA诊断SMAS的最佳诊断阈值为17.9°，对应诊断灵敏度为94%、特异度为53%。观察组、对照组ASD分别为（7.4±3.1）、（13.1±7.6）mm，...     

中年高血压病视网膜中央动脉彩色多普勒频谱研究

目的　研究中年高血压病不同危险层次患者视网膜中央动脉血流动力学变化规律。方法　应用彩色多普勒检测 3 79例中年正常人和 80 7例不同危险层次中年高血压病患者视网膜中央动脉血流频谱 ,测定收缩期峰值流速(PSV) ,舒张末期血流速度 (EDV) ,阻力指数 (RI)和搏动指数 (PI)。结果　高血压病与正常对照组PSV、EDV、RI、PI比较均有显著差异 (P <0 .0 1) ,高血压病患者视网膜中央动脉呈低流量、高阻力型改变。低危与中危者各参数相比无显著差异(P >0 .0 5 )。危险层次至中危后 ,随着危险层次的提高 ,PSV、EDV逐渐减低 ,RI、PI逐渐升高 (P <0 .0 1或P <0 .0 5 )。结论彩色多普勒能反映高血压病不同危险层次患者视网膜中央动脉血流动力学状况 ,有望成为临床评估高血压病病情危重度的一项定量检测手段     

乙型肝炎肝硬化腹水患者心脏血流动力学临床观察

目的研究乙型肝炎（乙肝）肝硬化腹水患者心脏血流动力学变化,探讨心脏血流动力学参数在肝硬化腹水中的临床意义。方法以27例乙肝肝硬化腹水患者为研究对象,将20例慢性乙肝患者设为对照组,采用无创血流动力检测仪测定心脏血流动力学参数。结果肝硬化腹水组的心率明显高于对照组（P〈0．05）;平均动脉压、每搏出量、每搏指数、全身血管阻力、全身血管阻力指数、左心作功和左心作功指数显著降低（P〈0．05）;心输出量和心脏指数较对照组无明显变化（P〉0．05）。结论心脏血流动力学参数可用于判断乙肝肝硬化腹水患者的心脏泵功能,为评价预后提供参考因素。     

肠系膜下动脉解剖分型在肠系膜下动脉结扎方式选择中的应用

目的探讨肠系膜下动脉（IMA）各种解剖分型及血管长度差异的相关因素，为结直肠癌低位结扎IMA提供参考。 方法前瞻性收集温州医科大学附属第一医院2019年7月至2020年4月因乙状结肠癌及直肠癌接受根治性手术治疗的患者的病例资料，术前使用增强CT对IMA进行重建，对IMA分型进行统计分析。并选取温州医科大学解剖教研室10具成人尸体，进行IMA解剖。 结果共纳入172例血管充盈可，重建效果佳的患者数据，纳入统计。按照Murono分型标准，其中Ⅰ型88例，Ⅱ型66例，Ⅲ型16例，Ⅳ型患者2例（不纳入后续统计分析）。170例患者中，IMA主干长（42.96±6.78）mm，体重是IMA主干长的主要影响因素（系数=0.253，P＜0.05），IMA主干长度=23.12+0.253×体重（R²=0.181）。体重每增加一个单位（kg），长度平均增加0.253个单位（mm）。 结论对IMA术前行增强CT可以了解IMA分型，有助于低位结扎位置的选择。可通过体重对IMA血管长度进行预估，从而选择最合适的血管处理方式。     

二维及彩色多普勒超声观察胃十二指肠动脉血流动力学参数

目的 :初步评估超声检测胃十二指肠动脉 （GDA ）、肝总动脉 （CHA ）的显示率与正常值范围 ,观察进食前后GDA、CHA血流参数的变化。方法 :应用二维及彩色多普勒超声分别测量 30例正常成人空腹和服用 2 5 0 g/ L葡萄糖 2 0 0 ml后 4 0 m in测 GDA、CHA的血流动力学参数的变化。结果 :正常成人 GDA二维超声与彩色多普勒显像的显示率分别为 91%和 96 % ,餐后 GDA、CHA血管内径、血流速度和血流量高于餐前 ,PI、RI变化不显著。结论 :掌握 GDA、CHA的检查方法及正常值范围对临床有重要意义 ,进餐对 GDA、CHA血流参数有显著影响。     

Changes in splanchnic hemodynamics in inflammatory bowel disease. Non-invasive assessment by Doppler ultrasound flowmetry.

An increase in splanchnic blood flow in both arterial and venous beds has been demonstrated in inflammatory bowel disease (IBD) by means of angiographic and scintigraphic studies. Doppler ultrasound (US) enables a non-invasive evaluation of splanchnic arterial inflow in the superior mesenteric artery (SMA) and of venous outflow in the portal vein. The aim of this study was to assess the role of Doppler US in detecting changes in the hemodynamic variables measured in patients with IBD. Forty-five patients with IBD were studied, including 22 with Crohn's disease (CD) and 23 with ulcerative colitis (UC), and compared with 45 matched normal subjects. The mean velocity of portal flow (Vmean) and the resistance index (RI) of the SMA were evaluated by Doppler US. In CD the Vmean of portal flow was significantly higher in patients with active disease than in controls (p less than 0.001) and patients with inactive disease (p less than 0.001). The RI of the SMA was significantly lower in active disease than in controls (p less than 0.005), but no significant difference was noted between active and inactive CD. Also in UC, the Vmean of portal flow was significantly higher in patients with active disease than in controls (p less than 0.01) and patients with inactive disease (p less than 0.05). The RI of the SMA was significantly lower in active disease than in controls (p less than 0.005) and in patients with inactive disease (p less than 0.005). Doppler follow-up studies were carried out in 10 patients after initiation of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mesenteric pulsatility index analysis predicts response to azathioprine in patients with Crohn's disease

OBJECTIVE: Mesenteric blood flow measurement has been found to predict relapse after steroid-induced remission in patients with Crohn's disease (CD) and ulcerative colitis (UC). Therefore, we assessed prospectively the possible relationship between changes in mesenteric blood flow and prognosis in chronically active patients with need of immunosuppressive therapy with azathioprine (AZA) or 6-mercaptopurine (6-MP). METHODS: Doppler ultrasound (DUS) measurements of the pulsatility index (PI) of the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) were performed in 52 patients with chronically active inflammatory bowel disease (CD 31 patients; UC 21 patients) before beginning therapy with AZA/6-MP (US1) and during clinical remission (CD activity index <150, Truelove index score I) (US2). Patients were weaned from concomitant therapy with corticosteroids as soon as possible and were followed up for 12 months. RESULTS: After 1 year, 16 patients with CD (51.6%) and 13 patients with UC (61.9%) were in remission, whereas 23 patients had recurrent disease or had undergone surgery. A decreased SMA PI at US2 predicted clinical relapse in all patients with CD [100%; P < 0.001; mean (+/-SD) 77 +/- 67 d after US1], but only 4 of 8 patients (50%; difference not significant; mean 84 +/- 75 d after US1) with UC. Conversely, an increase of SMA PI was associated with sustained remission in the majority of CD patients (12/16 patients; 75%; P < 0.002), but in only 7 of 13 patients (54%) with UC. Flow measurements in the IMA and postprandial values for both arteries were less reliable. CONCLUSION: Repeated DUS measurements of the SMA PI predict response to AZA/6-MP in patients with chronic active CD.     

Mesenteric blood flow is related to disease activity and risk of relapse in ulcerative colitis: a prospective follow up study

BACKGROUND: The diagnostic significance of increased splanchnic blood flow in ulcerative colitis is unclear. This prospective study was therefore undertaken to define the role of Doppler sonography in the assessment of disease activity and in the prediction of early relapse. SUBJECTS/METHODS: Splanchnic flowmetry was performed in 76 patients with ulcerative colitis (47 with active disease and 29 in remission), six with infectious colitis, and 13 healthy controls during fasting and 30 minutes after ingestion of a standardised meal. Twenty seven of the patients with ulcerative colitis and all patients with infectious colitis were investigated during the active state as well as in clinical remission and followed up for six months. Flow velocity and pulsatility index (PI) of the superior (SMA) and inferior (IMA) mesenteric arteries and the portal vein were related to clinical (Truelove index), laboratory (C-reactive protein), and endoscopic (Sutherland index) parameters of disease activity. RESULTS: The mean flow velocity of the IMA correlated closest with clinical activity (Truelove, r = 0.41, p<0.005), the PI with C-reactive protein (r = 0.30, p<0.05), and endoscopic activity (r = 0.45, p<0.001). All patients in remission after six months (14/14) or with infectious colitis (6/6) showed an increase in PI of the IMA compared with the initial measurement during active disease (mean increase for ulcerative colitis +36% and for infectious colitis +77%). In contrast, most patients with later relapse or surgery (11/13) had decreased PI during initial remission (mean decrease -12%). The positive predictive value of this index for maintenance of remission was 0.77. Flow variables of the SMA and portal vein displayed weaker correlations. CONCLUSIONS: Flow measurements in the IMA are closely related to clinical and endoscopic disease activity in patients with ulcerative colitis. Repeated measurement of the PI allows estimation of the risk of recurrence.     

Contrast-enhanced power doppler of the intestinal wall in the evaluation of patients with Crohn disease

BACKGROUND: Crohn disease (CD) manifests with highly variable signs and symptoms, and assessment of the status of the disease in the single patient can be difficult. This study was conducted to evaluate the efficacy of power colour Doppler ultrasonography, with and without echo-enhancement, in distinguishing active from quiescent CD. METHODS: Resistance Index (RI) of the superior mesenteric artery (SMA), bowel thickness of the affected loops and the presence of colour signals at power Doppler analysis prior to and after ultrasonography contrast agent injection (Levovist) were evaluated in 48 patients with CD. RESULTS: In our series, 26/48 patients had active and 22/48 had quiescent CD. A CDAI score > or = 150 and a pathological (> 5 mg/dL) C reactive protein were significantly correlated with active disease (P < 0.001 and P = 0.004, respectively). Intestinal wall thickness showed no significant correlation with disease status (7.5 +/- 1.3 mm in active disease versus 6.8 +/- 1.3 mm in quiescent disease; P = 0.11). Vascular signals in the affected loops were revealed in 11/22 patients (50%) with active disease and in 5/26 (20%) with quiescent disease (P = 0.052). After Levovist injection, colour signals were found in 22/22 with active and in 8/26 with quiescent CD (P < 0.001). SMA RI was significantly lower in active CD patients (0.81 +/- 0.01 versus 0.83 +/- 0.02; P = 0.001). CONCLUSIONS: Our data suggest that in patients with CD a finding of a SMA RI < or = 0.81, or the presence of a colour signal in the wall of the affected loops, at power Doppler sonography, is indicative of active disease. Utilization of echo-enhancer media can greatly improve the diagnostic sensitivity of intestinal wall power Doppler scan. A finding of intestinal wall thickening is not associated with active disease in our series.     

Increased circulating platelet-neutrophil, platelet-monocyte complexes, and platelet activation in patients with ulcerative colitis: a comparative study

It is reported that the incidence of thromboembolism is increased in ulcerative colitis (UC), and hypercoagulability persists even when patients are in remission. We evaluated the association of inflammatory response parameters with UC activity, and activation parameters of the platelets, endothelium, and the coagulation system in UC. Eighteen UC patients and 19 healthy subjects were included in the study. The patients' clinical features were recorded down; whole blood counts and acute phase parameters were evaluated. UC patients were divided into two as active (9 patients) and inactive (9 patients) according to combined clinical activity index (CAI) and endoscopic activity index (EAI) scores. In all subjects, platelet CD62P expression, platelet-monocyte complexes (PMC), platelet-neutrophil complexes (PNC), and platelet microparticles (PMP) were determined by flow cytometry. E-selectin, thrombin-antithrombin complex (TAT) levels in plasma, and sCD40L levels in serum were determined by ELISA. In both active and inactive UC patients, platelet CD62P expression, the percentages of PMC, and PNC were significantly higher than those in the control group (P< 0.01). PMP level was higher in the control group than in inactive UC patients (P = 0.001). sCD40L level was significantly higher in active UC group than in the control group (P < 0.01). EAI score correlated significantly with PMP (r = 0.5, P = 0.04) and sCD40L (r = 0.48, P = 0.044); CAI score had a negative correlation (r = -0.68, P = 0.002) with sE-selectin level. In addition to increased CD62P expression and sCD40L, increased formation of PMC and PNC suggests a role for platelet-leukocyte complex formation together with platelet activation in thromboembolic events observed in UC.     

Color Doppler sonography and angioscintigraphy in hepatic Hodgkin＇s lymphoma

AIM： To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography （HRA） in secondary Hodgkin＇s hepatic lymphoma.
METHODS： The research included patients with a diagnosis of Hodgkin＇s lymphoma with metastatic focal lesions in the liver and controls. Morphologic characteristics of focal liver lesions and hemodynamic parameters were examined by pulsed and Color Doppler in the portal, hepatic and splenic veins were examined. Hepatic perfusion index （HPI） estimated by HRA was calculated. was observed. Lesions were mostly hypoechoic and mixed, solitary or multiple. Some of the patients presented with dilated splenic veins and hepatofugal blood flow. A pulse wave was registered in the centre and at the margins of lymphoma. The average velocity of the pulse wave was higher at the margins （P 〉 0.05）. A continuous venous wave was found only at the margins of lymphoma. There was no linear correlation between lymphoma size and velocity of pulse and continuous wave （r = 390, P 〈 0.01）. HPI was significantly lower in patients with lymphomas than in controls （P 〈 0.05）, pointing out increased arterial perfusion in comparison to portal perfusion.
CONCLUSION： Color Doppler ultrasonography is a sensitive method for the detection of neovascularization in Hodgkin＇s hepatic lymphoma and estimation of its intensity. Hepatic radionuclide angiography can additionally help in the assesment of vascularisation of liver lesions.     

Ultrasound imaging in diagnosis of superior mesenteric artery syndrome

OBJECTIVES: We screened a cohort of subjects affected by various degree of dyspepsia to reveal if they presented a reduction of the aorto-mesenteric angle and to diagnose suspected cases of superior mesenteric artery (SMA) syndrome. DESIGN: Controlled, prospective, study. SETTING: Subjects were studied as outpatients. SUBJECTS: The study investigated a total of 3622 subjects referred to our department by their general practitioners for dyspepsia and/or abdominal pain. Interventions. Abdominal ultrasonography with power colour Doppler, gastroduodenoscopy, hypotonic duodenography, contrast-enhanced spiral computerized tomography were performed. MAIN OUTCOME MEASUREMENT AND RESULTS: Color Doppler revealed a significant reduction of the SMA angle in 29 of 950 subjects; gastroscopy showed duodenal compressive pulsation in 14 of 29 patients and X-ray revealed compression of the third segment of the duodenum in 28 of 29 patients. CT confirmed the presence of a reduced angle and various degrees of duodenal compression in all patients. Ultrasonography and CT examinations gave overlapping results (P > 0.05) in diagnosing pathological aorto-mesenteric angle. CONCLUSION: The authors believe that the incidence of reduced aorto-mesenteric angle and SMA syndrome might be underrated. Ultrasound power colour Doppler imaging is useful in epidemiological screening of reduced aorto-mesenteric angle to diagnose suspected cases of SMA syndrome.     

Abnormal function of platelets and role of angelica sinensis in patients with ulcerative colitis

AIM:To explore the abnormal function of platelets and the role of angelica sinensis injection (ASI) in patients with ulcerative colitis (UC).METHODS:In 39 patients with active UC, 25 patients with remissive UC and 30 healthy people, α-granule membrane protein (GMP-140) and thromboxane B2 (TXB2) were detected by means of ELISA, 6-keto-PGF1α was detected by radioimmunoassay, platelet count (PC) and 1min platelet aggregation rate (1min PAR) were detected by blood automatic tester and platelet aggregation tester respectively,and von Willebrand factor related antigen (vWF:Ag) was detected by the means of monoclonal-ELISA. The 64 patients with UC were divided into two therapy groups. After routine treatment and angelica sinensis injection (ASI)+routine treatment respectively for 3 weeks, all these parameters were also detected.RESULTS:The PC, 1min PAR and levels of GMP-140,TXB2, and vWF:Ag in active UC were significanrly higher than those in remissive UC and normal controls (P&lt;0.05-0.01).Meanwhile, 1 min PAR and levels of GMP-140, TXB2,and vWF:Ag in remissive UC were still significantly higher than those in normal controls (P&lt;0.05). Furthermore, 6-keto-PGF1-α level in active and remissive UC was remarkably lower than that in normal control (P&lt;0.05-0.01). These parameters except 6-keto-PGF1α were significantly improved after the treatment in ASI therapy group (P&lt;0.05-0.01),whereas they all were little changed in routine therapy group (P&gt;0.05).CONCLUSION:Platelets can be significantly activated in UC,which might be related with vascular endothelium injury and imbalance between TXB2 and 6-keto-PGF1α in blood.ASI can significantly inhibit platelet activation, relieve vascular endothelial cell injury, and improve microcirculation in UC.     

Faecal elastase reflects disease activity in active ulcerative colitis.

Alpha-1-proteinase inhibitor-bound elastase (EPIC) was measured in plasma and fresh stool samples from 20 patients with Crohn's disease (CD), 16 patients with ulcerative colitis (UC), and 10 controls. Median EPIC values were significantly higher than normal in active CD and UC. EPIC was virtually undetectable in the stool samples of control subjects. Median faecal EPIC in 14 patients with active CD (478 ng/ml) or 10 patients with active UC (1159 ng/ml) was significantly higher than in quiescent disease (p less than 0.05) and in control subjects (p less than 0.001 in each case). The difference in the median values between active CD and UC was not significant (p = 0.065). The median faecal EPIC levels were identical in active UC (1159 ng/ml) and patients with large-bowel CD (LBCD) (1015 ng/ml) (p = 0.9), and each was significantly higher than the value of 168 ng/ml in small-bowel CD (SBCD) (p less than 0.01 in each case). In active LBCD but not in SBCD, faecal EPIC correlated significantly with Crohn's disease activity index (R = 0.78, p less than 0.05), plasma C-reactive protein (CRP) (R = 0.9, p less than 0.01), and erythrocyte sedimentation rate (ESR) (R = 0.74, p less than 0.05). In active UC, faecal EPIC correlated significantly with a numerical disease activity index (R = 0.9, p less than 0.01) but not with plasma EPIC and CRP, ESR, and leucocyte counts. Faecal EPIC values may be a better reflection of disease activity in active UC than plasma levels of markers of inflammation.