失代偿期肝硬化患者肝静脉压力梯度与超声造影参数的相关性分析

目的考察失代偿期肝硬化患者的肝静脉压力梯度(HVPG)与超声造影参数的相关性,旨在探求无创评估失代偿期肝硬化患者门静脉压力的新方法。方法选取2014年10月~2015年10月在我院消化科进行诊治的失代偿期肝硬化患者89例。对所有患者行HVPG测定,并采集患者的超声造影动态图像,选择肝静脉、肝动脉、门静脉这3个感兴趣区进行分析,计算门静脉-肝静脉渡越时间(PV-HVTT)和肝动脉-肝静脉渡越时间(HA-HVTT)。将得到的超声造影参数与测得的HVPG进行Pearson相关性分析,并利用ROC曲线分析。结果肝静脉显影时间、门静脉-肝静脉渡越时间和肝动脉-肝静脉渡越时间与HVPG有相关性,呈负相关。ROC曲线分析结果显示:PV-HVTT≤2s(1.82)预测失代偿期肝硬化患者的HVPG≥12mm Hg的ROC曲线下面积为0.79,敏感性为0.64,特异性为0.81。而当PV-HVTT≤3s(1.73)时可预测HVPG≥16mm Hg的ROC曲线下面积为0.84,敏感性为0.77,特异性为0.78。结论超声造影是一种无创、安全、无辐射的诊断手段,门静脉-肝静脉渡越时间(PV-HVTT)与HVPG有相关性,可用于预测失代偿期肝硬化患者食管胃静脉曲张出血。     

超声造影评估肝炎肝纤维化及肝硬化的应用探讨

目的本研究旨在探讨超声造影在肝纤维化和肝硬化诊断中的应用价值。方法回顾性分析了我院相关科室共40例肝纤维化和肝硬化患者的临床资料,将超声造影用于肝纤维化和肝硬化的检测和诊断当中。肝纤维化组患者30例;肝硬化组患者10例;健康对照组10例。结果肝硬化组对比剂到达肝静脉的时间短于肝纤维化组和对照组（P〈0．05）;肝动-静脉渡越时间（HA-HVTT）在肝硬化组、肝纤维化组、对照组间的两两比较均具有统计学意义（P〈0．05）。肝纤维化组和肝硬化组的肝实质增强峰值时间比对照组长（P〈0．05）。结论超声造影在肝炎肝纤维化和肝硬化的检测和诊断中有重要的临床价值,能更好的指导肝炎肝纤维化和肝硬化疾病的临床治疗。     

超声造影对肝内孤立性坏死性结节血流动力学的诊断分析

目的探讨超声造影在诊断肝内孤立性坏死性结节（SNN）血流动力学中的应用价值。方法选择2010年1月至2014年1月在该院进行手术切除并经病理学证实为SNN的患者73例,对其常规超声和超声造影结果进行分析。超声造影从时间强度曲线中得到始增时间、始增强度、达峰时间、峰值强度、强度差值、上降支斜率、渡越时间,并与相应正常肝组织区域比较进行统计学分析。最后比较常规超声和超声造影诊断SNN的准确率。结果 62例病灶在肝动脉相、门静脉相及延迟相中均无明显造影剂灌注;另有8例病灶边缘在动脉相有环状强化;余下3例病灶在动脉相及门静脉相有少许显影。SNN患者在峰值强度、强度差值及渡越时间3个参数上与周围正常肝组织比较,差异均有统计学意义（P〈0.05）。超声造影诊断SNN的准确率高于常规超声,差异有统计学意义（P〈0.05）。结论超声造影有助于发现SNN的血流动力学特征规律,对提高SNN的诊断准确率有一定帮助。     

64层螺旋CT灌注成像对肝硬化定量评估的临床研究

目的应用64层螺旋CT灌注技术测量肝硬化患者的血流灌注,研究64层螺旋CT对肝硬化病变程度的定量、无创评估。方法对42例不同肝功能分级(Child-Pugh)的肝硬化患者进行64层螺旋CT灌注扫描,测得其肝脏、脾脏以及主动脉的时间密度曲线(TDC),获得肝动脉灌注量(HAP)、门静脉灌注量(HPP)和肝动脉灌注指数(HPI)=HAP/(HAP+HPP)。研究灌注参数与Child-Pugh分级之间的关系。结果与健康对照组比较,肝硬化组的动脉期、门静脉期以及肝脏实质期的TDC曲线均较健康组上升缓慢、峰值延迟、峰值下降以及下降也缓慢。Child-Pugh A以及B级肝硬化的HAP同对照组比较降低有统计学意义(P=0.01,0.02),Child-Pugh C级与对照组的HAP比较无统计学意义(P=0.63)。对于HPP,肝硬化Child-Pugh A级组与健康组比较下降有统计学意义(P=0.01),Child-Pugh B级组与健康组比较降低也有统计学意义(P=0.00)。Child-Pugh C级与A级组HPP下降有统计学意义(P=0.01)。结论肝脏的CT灌注可以反映肝硬化的血流变化,为肝硬化的病变程度进行定量评估提供参考。     

超声造影评估2型糖尿病合并微血管病变骨骼肌微循环及动脉灌注储备的效果

目的 探讨超声造影评估2型糖尿病(type 2 diabetes mellitus,T2DM)合并微血管病变(MC)骨骼肌微循环及动脉灌注储备的效果。方法 选取2021年6月至12月在厦门市第五医院进行健康体检的健康人群20名作为对照组,同时选取20例同期在厦门市第五医院就诊的T2DM患者作为DM组,选取20例同期在厦门市第五医院治疗T2DM合并MC患者作为DM+MC组,三组均行超声造影检查,并配合短暂动脉闭塞检查,分析三组患者骨骼肌微循环及动脉灌注储备情况。结果 DM+MC组部分造影剂渡越时间长于DM组及对照组,差异有统计学意义(P<0.05);短暂闭塞后,DM+MC组造影剂渡越时间长于DM组及对照组,差异有统计学意义(P<0.05);DM+MC组血糖、糖化血红蛋白、胰岛素、胰岛素抵抗指数、C-反应蛋白值、D-二聚体水平均高于DM组及对照组,差异有统计学意义(P<0.05);经相关性分析,糖化血红蛋白、胰岛素抵抗指数、C-反应蛋白值、D-二聚体水平和各组造影剂渡越时间及短暂动脉闭塞后各组造影剂渡越时间均存在正相关性(P<0.05)。结论 超声造影在评估T2DM...     

超声诊断早期肝硬化的临床价值分析

目的探讨超声诊断早期肝硬化的临床价值及意义。方法将65例早期肝硬化患者(观察组)与60例正常体检者(对照组)的超声检查资料进行回顾性分析,观察两组肝实质情况及血流动力学参数情况,并进行对比分析。结果门静脉血流较正常人有明显增宽,血流速度明显减慢,峰值流速减低;脾静脉血流较正常人明显增粗、增多,两组血液动力参数比较有显著差异(P<0.05)。结论超声检测能能清楚判断门静脉血流动力学信息,可作为诊断早期肝硬化的一个重要依据。     

双能碘图无创评价肝硬化门静脉高压症

目的 探讨应用双源CT双能量碘图来无创评价肝硬化门静脉高压患者的门静脉血流动力学变化。方法 对2019年12月—2021年12月期间河南中医药大学第一附属医院门脉高压组(肝硬化患者50例)、正常对照组(22例正常人)均采用双能扫描序列进行双期增强扫描,测量肝脾动脉期、静脉期碘浓度及门静脉主干碘浓度。结果 (1)门静脉高压组肝脏动脉期碘浓度(0.74±0.22)mgI/mL较对照组(0.50±0.12)mgI/mL高(t=6.092,P<0.05);门静脉高压组肝脏静脉期碘浓度(1.87±0.26)mgI/mL较对照组(2.14±0.32)mgI/mL低(t=3.825,P<0.05);门静脉高压组脾脏动脉期碘浓度(3.79±1.16)mgI/mL较对照组(3.03±0.82)mgI/mL高(t=2.728,P<0.05);门静脉高压组脾脏静脉期碘浓度(2.66±0.47)mgI/mL与对照组(2.58±0.63)mgI/mL相比无统计学差异(t=0.580,P>0.05);门静脉高压组门静脉主干碘浓度(4.11±0.65)mgI/mL高于对照组(5.35±0.4...     

超声弹性成像及超声造影技术评估慢性乙肝肝纤维化程度的临床研究

目的　探讨声触诊组织量化（VTQ）及超声造影（CEUS）技术对慢性乙肝肝纤维化程度的诊断价值。方法　65例慢性乙肝患者分别进行VTQ、CEUS技术检查及肝穿刺活检,获取剪切波速度（SWV）及造影参数：门静脉到达时间（PVAT）、肝动脉到达时间（HAAT）、肝静脉到达时间（HVAT）、肝实质达峰时间（TTP）、肝动脉-肝静脉渡越时间（HV-HAAT）、肝动脉-门静脉渡越时间（PV-HAAT）。根据病理结果分为轻度组12例、中度组23例和重度组30例,比较各组SWV和CEUS参数差异,分析SWV、CEUS参数与肝纤维化程度的相关性,绘制受试者工作特征（ROC）曲线,寻找SWV、CEUS参数诊断重度肝纤维化的截断值,计算曲线下面积（AUC）,评价SWV、CEUS参数对重度肝纤维化的诊断效能,采用DeLong法比较不同检测方法的AUC差异。结果　与轻度组比较,中度组和重度组SWV增大,重度组HVAT、HV-HAAT减小（P＜0.05）;与中度组比较,重度组SWV增大,HVAT、HV-HAAT减小（P＜0.05）。SWV与肝纤维化严重程度呈正相关（rs=0.713,P＜0.05）,HVAT、HV-HAAT与肝纤维化严重程度呈负相关（rs分别为 -0.437、-0.620,P＜0.05）;SWV、HVAT、HV-HAAT诊断重度组肝纤维化（肝硬化）的AUC（95%CI）分别为0.925（0.832~0.976）、0.734（0.610~0.836）、0.804（0.687~0.892）,截断值分别为1.92 m/s、21.02 s、8.23 s;SWV的诊断效能优于HVAT、HV-HAAT（Z分别为2.817和1.987,均P＜0.05）。结论　与CEUS相比,VTQ技术对慢性乙肝肝纤维化程度的诊断效能更佳。     

肝血管瘤灰阶谐波超声造影时相研究

目的 利用灰介谐波超声造影技术研究肝血管瘤造影增强的时相变化并探讨其对血管瘤的诊断价值.方法 对30例肝血管瘤病灶进行超声造影检查,观察血管瘤的造影增强表现方式和时相规律.造影剂选用SonoVue,经肘静脉快速团注.结果 30个(100%)病灶均在动脉相出现增强,回声高于肝实质.其中26个(86.7%)病灶在门静脉相和延迟相持续增强,回声始终高于肝实质.在动脉相初始强化时,27个(90%)病灶呈环状或周边结节状增强逐渐向中央充填.在门静脉相和延迟相达峰值时,26个(86.7%)仍表现为周边结节状增强.结论 肝血管瘤超声造影增强的主要特点为动脉相回声增强,门脉相和延迟相持续性增强仍不低于肝实质回声;增强从周边开始呈进行性完全或部分性向心性填充.超声造影有助于肝血管瘤的诊断.     

促肝细胞生长素联合乌鸡白凤丸治疗肝硬化65例疗效观察

目的:观察促肝细胞生长素(PHGF)联合乌鸡白凤丸治疗肝硬化的临床疗效。方法:97例肝硬化患者随机分为2组,对照组(32例)给予常规综合治疗,治疗组(65例)在常规综合治疗基础上加PHGF联合乌鸡白凤丸治疗。2组疗程均为3个月,分别观察患者治疗前后的主要症状、体征、肝功能、凝血功能、肝纤维化指标及彩色多普勒超声下门静脉内径(PVD)和脾静脉内径(SVD)、脾脏厚度(SPT)的变化。结果:治疗组症状和体征较对照组有改善,总有效率(84.62%)显著高于对照组(59.38%)(P<0.01);治疗组肝功能AST、ALT、TBil、GLB较对照组降低,ALB、PTA较对照组升高(P<0.05,P<0.01);治疗组肝纤维化指标(HA、LN、PCⅢ、CⅣ)及反映门静脉高压严重程度的指标(PVD、SVD、SPT)较对照组降低(P<0.05,P<0.01)。结论:PHGF联合乌鸡白凤丸治疗肝硬化有较好改善肝功能和抗肝纤维化的作用。     

肝血管瘤超声造影表现

目的回顾性研究肝血管瘤超声造影（CEUS）的表现,总结肝血管瘤超声造影检查的表现特征。方法通过运用对比脉冲序列成像（CPS）技术对17例肝血管瘤（共21个病灶）进行超声造影检查,从而观察其动脉期、门脉期及延迟期的增强表现。结果超声造影肝血管瘤主要表现为动脉期或门脉早期周边环状、结节状增强,门脉期缓慢向心性充填,延迟期为最大增强。结论肝血管瘤在肝脏实时超声造影检查中具有特异性表现,可提高诊断准确率。     

肝硬化患者脾静脉血流动力学改变及临床意义探讨

目的　对肝硬化患者脾静脉血流与门静脉血流的关系及其临床意义进行探讨。方法　依据Child-Pugh记分对 76例肝硬化患者分为A级、B级、C级 3个组 ,应用彩色多普勒超声技术对患者的脾静脉、门静脉的内径、时间平均流速进行了检测 ,计算了二者的血流量及其比值。并设置了正常对照组。结果　A级、B级、C级 3个组的脾静脉血流量 (SVF)均较对照组显著增多 (P均 <0 . 0 1) ,且B级、C级组的脾静脉血流量较A级组增多 (P均 <0 .0 5 ) ,SVF/门静脉血流量 (PVF)比值 3个组都较对照组显著增高 (P均 <0 . 0 1) ,C级组较B级组升高 (P <0 . 0 5 ) ,且C级组中患者的胃左静脉扩张率高于A级、B级两组 (P <0. 0 5 ,P <0. 0 1) ,血流量增加 (P <0 . 0 5 ,P <0 .0 1)。结论　随着脾静脉血流量的增多 ,SVF/PVF值增大 ,肝硬化患者的食管静脉曲张和出血有升高趋势。     

Effect of vardenafil, an inhibitor of phosphodiesterase-5, on portal haemodynamics in normal and cirrhotic liver -- results of a pilot study

BACKGROUND: Dysregulation of the cyclic guanosine 3',5' monophosphate-nitric oxide system is in part responsible for portal hypertension in cirrhosis. AIM: To test the effects of inhibitors of phosphodiesterase-5 on portal haemodynamics. METHODS: To 18 healthy subjects and 18 patients with Child A liver cirrhosis, 10 mg of vardenafil, an inhibitor of phosphodiesterase-5, were administered orally. Doppler sonographic measurements of hepatic and splanchnic blood flow, systemic blood pressure and heart rate were recorded before, 1 h after, and 48 h after the application. Vardenafil plasma levels were determined after 1 h. In five patients, invasive registration of free and wedged hepatic vein pressure was performed. RESULTS: Portal venous flow increased in patients from 0.82 +/- 0.30 L/min (mean +/- s.d.) by 26% (CI: 16-37%, P = 0.0004) and in healthy subjects from 0.75 +/- 0.20 L/min (mean +/- s.d.) by 19% (CI: 9-28%; P = 0.0010). Celiac and hepatic artery resistivity indices rose significantly. Systemic blood pressure decreased slightly in patients. The wedged hepatic venous pressure gradient decreased in four of five patients with liver cirrhosis. Vardenafil plasma levels were higher in patients (14 +/- 10 microg/L) than in healthy subjects (9 +/- 6 microg/L; n.s.). CONCLUSIONS: Inhibition of phosphodiesterase-5 increases portal flow and lowers portal pressure by a decrease in sinusoidal resistance and may be a novel therapeutic strategy for portal hypertension.     

实时超声造影对肝硬化背景下占位病变的鉴别诊断

目的分析实时超声造影对肝硬化伴占位性病变的血流灌注特征,探讨良恶性占位病变的诊断和鉴别诊断价值。方法对经病理证实的78例肝硬化患者中102个病灶,采用低机械指数（MI0.06-0.10）反向脉冲谐波造影成像技术进行实时超声造影观察,并与常规彩超和增强CT对照分析。结果超声造影、增强CT、常规彩超诊断肝癌的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为97.8%、93.9%、95.7%、96.9%、96.2%和93.3%、93.9%、95.5%、91.2%、93.6%以及60%、66.7%、71.1%、55%、62.8%。本组资料表明,超声造影、增强CT与病理诊断具有很高的一致性（Kappa值分别为0.93、0.87）,明显高于常规彩超（Kappa值为0.26）。结论超声造影对肝硬化背景下再生结节与原发性肝癌的诊断和鉴别诊断具有重要的临床价值。     

肝癌及门静脉癌栓血供灌注特征的彩超与超声造影研究

目的探讨彩超(CDUS)与超声造影(CEUS)对不同类型肝癌及门静脉癌栓(PVTT)的血供灌注特征及临床价值。方法应用CDUS及CEUS对经临床证实的369例437个不同类型肝癌病灶及合并的PVTT进行血供灌注特征和血流动力学变化的研究分析。结果①肝癌血供灌注呈多样性:肝动脉血供为主型占72.8%(318/437),肝动脉和门静脉双重血供型占16.7%(73/437),肝动脉和门静脉双重血供兼动静脉瘘型占8.2%(36/437),门静脉血供为主型占2.3%(10/437)。②PVTT血供灌注也呈多样性,即肝动脉血供型或双重血供型。③肝癌血供的CEUS初始强化形态与肿瘤血管分布状态密切相关。结论 CEUS可明确判定肝癌及合并的PVTT的血供灌注特征,对肝癌的诊断、鉴别诊断及治疗方案的选择有重要的临床价值。     

硬化剂注射预防食管静脉曲张破裂出血远期疗效研究

目的观察肝硬化食管静脉曲张患者分别行内镜下注射硬化剂（endoscopic injection sclerotherapy,EIS）和口服卡维地洛后的再出血发生率、死亡率和治疗前后食管静脉曲张程度以及肝功能的分级变化。方法入选患者89例,其中50例患者采用EIS治疗,39例患者采用药物预防性治疗,EIS组患者给予多次注射硬化剂,直至曲张静脉消失,药物治疗组给予卡维地洛,起始剂量为6.25mg,每日2次,逐渐增加剂量至最大耐受量12.5mg,每日2次。全部患者观察36个月,对比两组间的再出血发生率和死亡率、治疗前后静脉曲张程度以及肝功能分级变化。结果 EIS治疗组有效随访44例,期间发生出血7例（15.9%）,死亡3例（6.8%）。药物治疗组有效随访34例,期间发生出血10例（29.4%）,死亡4例（11.8%）。两组间再出血发生率和死亡率差异有统计学意义（P〈0.05）。EIS治疗组静脉曲张总消失率为40.9%（18/44）,卡维地洛治疗组曲张静脉均未消失;比较两组治疗前后肝功能Child-Pugh评分未见明显差异（P〉0.05）。结论与药物卡维地洛治疗相比,EIS治疗可以降低再出血发生率、死亡率和静脉曲张程度,同时患者肝功能无明显损害。     

Omapatrilat in patients with hepatic cirrhosis. Pharmacodynamics and pharmacokinetics

OBJECTIVE: The pharmacodynamics and pharmacokinetics of omapatrilat, a member of a new class of cardiovascular compounds, the vasopeptidase inhibitors, were evaluated in subjects with hepatic cirrhosis (n = 10) and in healthy subjects (n = 10) matched for age, weight, gender and smoking history. METHODS: All subjects received omapatrilat 25 mg orally once daily for 14 days. Plasma renin and urinary atrial natriuretic peptide (ANP) levels were measured to assess the effect of omapatrilat on cirrhotic subjects. The effect of omapatrilat on blood pressure as well as changes in ANP and plasma renin levels were not altered by hepatic impairment. Pharmacokinetic parameters were determined from plasma omapatrilat concentrations. RESULTS: There were no significant differences between the two subject groups with regard to log-transformed area under the curve or maximum observed plasma concentration. Systemic accumulation was similar in the two groups. CONCLUSION: These results suggest, based on findings in otherwise healthy cirrhotic subjects, that no adjustment of standard dosing regimens is indicated for hypertensive patients with mild to moderate cirrhosis.     

Ursodeoxycholic acid reduces increased circulating endothelin 2 in primary biliary cirrhosis

BACKGROUND: Endothelins and nitric oxide regulate sinusoidal blood flow and the perfusion of the peribiliary vascular plexus. AIMS: To study the serum and hepatic vein concentration of ET-1, ET-2, ET-3 and nitric oxide in patients with primary biliary cirrhosis and the effect of ursodeoxycholic acid treatment. METHODS: Endothelins and nitrites/nitrates were measured in serum and hepatic vein blood in primary biliary cirrhosis and viral cirrhotic patients prior and after ursodeoxycholic acid therapy and in serum in controls. Endothelins were measured with commercial enzyme-linked immunosorbent assays and nitrites/nitrates with a modification of Griess reaction. RESULTS: The ET-1 and ET-3 levels were similar in patients and controls. Primary biliary cirrhosis patients had the highest serum ET-2 (P < 0.001) compared with other groups. Nitrites/nitrates was increased in primary biliary cirrhosis (P < 0.05) compared with normal. ET-2 and nitric oxide were similar in all primary biliary cirrhosis stages. Ursodeoxycholic acid significantly decreased ET-2 in all stages (I and II: P < 0.05 and III and IV: P < 0.01) and increased nitric oxide (P < 0.05) in early primary biliary cirrhosis. Hepatic vein ET-1 and ET-3 were higher in viral cirrhosis patients, but only in primary biliary cirrhosis a significant difference for ET-1 and ET-3 between hepatic and peripheral veins was found. CONCLUSIONS: Increased ET-2 is an early defect in primary biliary cirrhosis that is significantly reduced by the ursodeoxycholic acid treatment. The possibility of a more generalized endothelial cell dysfunction in primary biliary cirrhosis requires further investigation.     

Bolus somatostatin but not octreotide reduces hepatic sinusoidal pressure by a NO-independent mechanism in chronic liver disease

BACKGROUND: Evidence exists that somatostatin and octreotide might have different effects on hepatic haemodynamics. AIM: The investigation of the effects of somatostatin and its octapeptide analogue, octreotide, on sinusoidal pressure measured by the wedged hepatic venous pressure in patients with cirrhosis or chronic hepatitis and the correlation with the levels of hepatic vein NO. METHODS: Patients were randomly assigned to receive an injection of either 250 microg somatostatin (n=14: cirrhosis six, chronic hepatitis eight) or an injection of 125 microg octreotide (n=19: cirrhosis nine, chronic hepatitis 10) during hepatic vein catheterization. Baseline wedged hepatic venous pressure was measured, followed by measurements at 2, 5, 10 and 15 min after the injection of the drug. Nitrites/nitrates of the hepatic vein were measured before the injection and after 15 min. RESULTS: Both agents showed a similar qualitative but a different quantitative haemodynamic profile. No change in the wedged hepatic venous pressure was observed during the first 2 min after the injection of both drugs. This was followed by a decrease: 18% at 5 min (N.S.), 23% at 10 min (P < 0.01) and 24% at 15 min (P < 0.01) for somatostatin. Octreotide induced a relatively smaller decrease in the wedged hepatic venous pressure: 8% at 5 min (N.S.), 20% at 10 min (P < 0.01) and 16% at 15 min (N.S.). Further analysis of the sub-groups of cirrhotic and chronic hepatitis patients revealed a different effect. In the sub-group of cirrhotic patients, somatostatin caused a maximum decrease of 34% at 15 min post-injection (P < 0.01), but octreotide failed to produce a significant change on the wedged hepatic venous pressure. In contrast, no change was observed in chronic hepatitis patients with either drug. No change in the hepatic vein concentration of NO after treatment was observed with either somatostatin or octreotide. Moreover, no correlation of the levels of NO with the wedged hepatic venous pressure values was found. CONCLUSIONS: This study shows that somatostatin is more effective than octreotide in acutely reducing the wedged hepatic venous pressure after bolus injection and the observed change is probably mediated by a NO-independent mechanism.