超声检测门脉高压患者肝脾动脉阻抗指数与门脉压力相关性研究

目的探讨肝动脉、脾动脉阻力指数（HARI、SpARI）及门脉高压指数（PHI）在评价门脉高压中的应用价值。方法57例临床确诊门脉高压并行门奇断流或脾肾分流术的患者被纳为门脉高压组,对照组为25例健康志愿者。门脉高压组均在术前1d行超声检查,对照组在空腹8h以上行超声检查。采用频谱多普勒检测门静脉平均血流速度（PVVel）、HARI、SpARI及肝脾动脉搏动指数（HAPI、SpARI）,并计算门脉高压指数（PHI）。门脉高压组门脉压力以术中胃网膜右静脉直接测压为准。结果对门脉高压组采用直接压力测定法测得门脉压力为（30.090±4.151）mmHg。门脉高压组HAPI、SpAPI及PHI高于正常对照组（P=0.012,P=0.034,P=0.026）,而PVVel、HARI及SpARI在两组之间差异无统计学意义。以HAPI=1.34诊断门脉高压的敏感性为73%、特异性80%、准确性74%。HARI、HAPI与门脉压力呈显著正相关（r=0.699,r=0.582,P均〈0.001）。门脉压力与肝功能Child-Pugh分级呈显著正相关（r=0.589,P=0.044）。结论HAPI在门脉高压组显著高于正常对照组,且与门脉压力呈显著正相关,因此HAPI可作为评价门脉高压的有效指标。

Doppler ultrasonographic evaluation on the correlation of portal pressure and impendence indices of hepatic and splenic artery

Objective The aim of this study was to investigate the value of hepatic and splenic impendence indices, and portal hypertension index （PHI） in the portal hypertension patients, Methods Fifty-seven patients having been diagnosed clinically as portal hypertension accepted portosystemic shunts surgical therapy were enrolled in our study, and 25 healthy subjects served as the controll group. Doppler ultrasonographic examination was performed day 1 before operation in PHT group and 8 h fasting in control group. Portal vein velocity （PVVel）, resistive index of hepatic artery （HARI） and splenic artery （SpARI）, pulsatility index of hepatic artery （HAPI） and splenic artery （SpAPI） were measured using pulsed Doppler ultrasound. PHI was calculated. The portal vein pressure was measured directly from the gastroepiploic vein during surgical operation. Results The directlly measured portal pressure was 30. 090 ± 4. 151 mm Hg. Doppler parameters of HAPI, SpAPI and PHI in patients with portal hypertension were statistically higher than those of healthy controls （ P = 0. 012, P = 0. 034, P = 0. 026, respectively）, while PVVel, HARI and SpRI in PHT group showed no significant difference compared with the control group. HAPI of 1.34 as the cutoff value was suitable for the diagnosis of portal hypertension with sensitivity of 73%, the specificity of 80% and accuracy rate of 74%. Portal pressure was significantly correlated with hemodynamic characteristics of HARI （ r = 0. 699, P 〈 0. 001 ） and HAPI （ r = 0. 582, P 〈 0. 001 ）, respectively. A significant linear correlation was found between portal pressure and Chlid-Pugh score （ r = 0. 589, P = 0. 044）. Conclusions In portal hypertension group, splanchnic flow parameter HAPI indicates not only significant difference from healthy controls, but also correlates with portal venous pressure significantly. Therefore, HAPI may contribute to the noninvasive evaluation of portal hypertension.