肝硬化肝脏流入道血流动力学变化与肝功能的相关性研究

目的探讨肝硬化肝脏流人道血流动力学改变与肝功能Child—Pugh分级的相关性。方法彩色多普勒血流显像技术检查80例乙肝病毒性肝硬化（VLC）患者和50例酒精性肝硬化（ALC）患者的肝固有动脉和门静脉主干的血流参数，计算血流灌注指数（DPI），并与对照组（50例）进行比较。结果VLC组、ALC组肝固有动脉峰值流速（PSV）分别为（74．1±30．5）cm／s和（41．5±7．2）cm／s，时间平均流速（TAVMHA）为（26．9±5．5）cm／s和（37．1±14．2）cm／s，阻力指数（RI）为0．72±0．06和0．73±0．05，搏动指数（PI）分别为1．6±0．44和1．7±0．29，血流量（QHA）分别为629．5±206．1和263．4±89．9；门静脉主干最大血流速度（Vmax）为（13．2±3．4）cm／s和（12．1±4．2）cm／s，血流量（Qpv）为945．5±346．9和670．0±190．5。VLC组、ALC组与对照组比较，门静脉主干内径（Dpv）、肝固有动脉内径（DHA）增宽，Vmax降低；RI、PI均高于对照组。肝硬化病变组与对照组血流动力学参数比较差异有统计学意义（P〈0．05）。VLC组和ALC组问血流动力学变化因病因的不同也有较大差异，VLC组Qpv降低，QHA则呈代偿性增高；而ALC组QHA总体呈下降趋势，RI、PI明显高于VLC组。肝硬化患者肝固有动脉血流速度、QHA随Child—Pugh肝功能分级的加重逐渐增大，与之呈正相关；门静脉的Vpv、Qpv随Child—Pugh肝功能分级的加重逐渐减少，与之呈负相关；其DPI与Child—Pugh肝功能分级亦有很好的相关性。VLC组、ALC组与Child—Pugh肝功能分级的相关系数（r值）分别为：0．71、0．69（P=0．000）。结论肝硬化肝脏整体流人道血流动力学的变化与Child—Pugh肝功能分级有较好的相关性，肝动脉血流的特异性改变为不同病因所致肝硬化的诊断提供依据．对肝硬化的预防和治疗县右重要煮义．

The correlation study on the change of liver inflow tract hemodynamics and liver function by color Doppler ultrasonography in patients with cirrhosis

Objective To investigate the correlation between the changes of liver inflow tract hemodynamics and the Child - Pugh grade in patients with cirrhosis. Methods The hemodynamic parameters of hepatic artery and portal vein in 80 patients with liver cirrhosis （LC） caused by hepatitis B virus and 50 patients with alcoholic cirrhosis were examined by color Doppler flow imaging technique. Then the Doppler perfusion index （ DPI ） was caculated and the results were compared with control group and analyzed according to Child - Pugh grade. Results The hemodynamic parameters of hepatic artery and portal vein in VLC group and ALC group were as follow： The peak systolic velocity （PSV） （74.1 ± 30.5cm/s ;41.5± 7.2cm/s） ;the resistent index （RI） （0.72 ±0.06;0.73 ±0.05） ; the pulsatility index（PI） （1.6 ±0.44;1.7±0.29） ; the blood flow （Q,A） （629.5 ±206.1; 263.4± 89.9） ; the Vmax of the portal vein（13.2±3.4 cm/s ; 12. 1±4.2 cm/s ） ; the Qpv（945.5 ± 346. 9; 670 ± 190.5）. The Dpv, DHAwere widen in VLC group and ALC group, the flow rate of Vpv was decreased, and Qpv was decreased too, RI and PI were higher than those in control group, there was significant difference between VLC group, ALC group and control group The haemodynamic changes had significant difference with different etiological factor in VLC group and ALC group. Qpv was decreased and QHA was compensated increased in VLC group, while QHA was globally decreased in ALC group, RI and PI in ALC group were obviously higher than those in VLC group. PSV, QHA were gradually increased and the Vpv, Qpv were gradually decreased with the increasing of Child - Pugh grade in patients with LC. There was good correlation between the DPI and the Child - Pugh grade , and the r value was 0.71 in VLC group and 0. 69 in ALC group（ P = 0. 000 ）. Conclusion There is good correlation between the changes of liver inflow tract hemodynamics and the Child - Pugh grade in patients with cirrhosis. The specificity changes of hepatic arte