能量多普勒应用于肝硬化进程中肾脏血流动力学观测的价值

目的：探讨能量多普勒显像（PDI）应用于肝硬化病理中肾脏血流动力学观测的价值。方法：应用PDI技术检测不同病程肝硬化患者肾脏血流动力学变化，并与正常人对照。结果：肝硬化代偿组，PDI示肾脏血流丰富，各级动脉呈现完整的血管树分布，肾血流量（V）和阻力指数（RI）与对照组差异不显著（P＞0．05）。肝硬化失代偿期，PDI示肾内血流减少，外层皮质血流缺失，弓形动脉血流断续出现，叶间动脉变细。V较代偿期及正常组显著减少（P＜0．01），而RI显著升高（P＜0．01）。肝肾综合征（HRS）期，PDI示肾内血流明显减少，皮质血流极少显示，叶间动脉及段动脉变细，边缘缺损，叶间动脉可呈片状缺失。V较其它三组均显著减少（P＜0．05或P＜0．01），RI则显著升高（P＜0．05或P＜0．01）。结论；PDI技术结合肾动脉血流参数测定能客观反映肝硬化患者肾脏血流动力学紊乱程度，对其病情监测，HRS的预测和诊断均有重要价值。

Value of PDI in Renal Blood Flow Detection in Patients with Hepatic Cirrhosis

Objective:To evaluate the value of PDI in the renal blood detection in patients with hepatic cirrhosis.Methods:The renal hemodynamic changes in patients with hepatic cirrhosis were observed with PDI and compared with those in the control.Results:We found no significant differences in the renal blood flow between normal subjects and compensated cirrhotic patients However,the renal arterial blood flow signals in the decompensated patients were decreased,the resistance index(RI) was significantly higher than those of the healthy subjects and the compensated patients ( P <0 01) and the renal arterial inflow (V) was markedly reduced ( P <0 01) In patients with hepatorenal syndrome (HRS),the renal blood flow signals showed significantly lower than those of the other three groups V was also significantly reduced( P <0 01) with respect to the control subjects and the compensated subjects and reduced( P <0 05)with respect to the decompensated patients Thus,RI was markedly increased ( P <0 01) with respect to control subjects and compensated subjects and increased ( P <0 05) with respect to the decompensated patients.Conclusions:PDI and its flow parameters can objectively reflect the disorders of the renal hemodynamics in patients with hepatic cirrhosis and is valuable for monitoring the progress of the disease and for predicting and diagnosing HRS.