乙型肝炎肝硬化患者中医证型与超声影像学特征的关系

目的:探讨乙型肝炎肝硬化患者中医证型与肝脾大小及门静脉血流动力学的关系。方法:用彩超仪检测150例不同中医证型肝硬化(分为6型)患者的肝右叶最大斜径、前后径,肝左叶上下径、前后径,门静脉及脾静脉内径、血流速度,脾脏大小等超声指标,进行对比分析。结果:肝硬化血瘀证患者与肝气郁结证、湿热内蕴证、肝肾阴虚证患者相比,肝左叶上下径的差异有显著性意义(P<0.05);肝硬化湿热内蕴证患者与血瘀证患者相比,脾脏厚度差异有显著性意义(P<0.05);肝硬化湿热内蕴证患者与肝肾阴虚证、脾肾阳虚证、血瘀证患者相比,门静脉主干内径差异有显著性意义(P<0.05);肝硬化血瘀证患者与肝气郁结证患者相比,门静脉血流流速差异有显著性意义(P<0.01);脾静脉内径、血流流速各型之间比较差异无显著性意义。结论:超声检查对肝硬化中医辨证分型有一定指导意义,随着证型的发展,肝脾大小及门静脉血流动力学有相应改变。

Study on the correlation between the ultrasonic feature and the syndrome types of TCM of liver cirrhosis

Objective:To approach the relationship between the size of liver and spleen and the portal vein haemodynamics in patients with different traditional Chinese medical syndromes of liver cirrhosis.Methods:One hundred and fifty cases of liver cirrhosis with different syndromes were included in the study.The largest oblique diameter and anteroposterior diameter of right hepatic lobe,the length and anteroposterior diameter of left hepatic lobe,diameters and blood flow velocity of the potal vein and splenic vein,and the size of spleen were tested by color Doppler sonarography.Results:The length of left hepatic lobe in patients with the blood stasis syndrome was significantly different to that of stagnation of liver Qi,or internal accumulation of damp-heat,or hepatic and renal Yin deficiency,respectively(P<0.05).The thickness of spleen in patients with internal accumulation of damp-heat and the blood stasis syndrome were significantly different(P<0.05).Diameter of the main portal vein in patients with internal accumulation of damp-heat were significantly different to that of the hepatic and renal Yin deficiency,or the asthenic splenonephro-Yang,or the blood stasis syndrome,respectively(P<0.05).The blood flow velocity of the portal vein with the blood stasis syndrome was significantly different to the stagnation of liver Qi(P<0.01).Diameter and the blood flow velocity of the splenic vein in patients with different syndromes were not significantly different.Conclusion:Ultrasonograph has an important guide sense to the syndrome differentiation of liver cirrhosis,the size of liver and spleen and the blood flow velocity of the portal vein changed with the development of the syndromes.