肝硬化门脉高压患者门-腔分流状态对肝脏血流灌注的影响

目的应用肝脏CT血流灌注扫描和多层螺旋CT门静脉造影技术(CTPV),评价肝硬化患者门-腔静脉之间侧支循环的形成情况对肝脏血流灌注的影响。方法对我院101例肝硬化合并门静脉高压患者作CT血流灌注扫描和多层螺旋CT门静脉造影。计算肝血流灌注参数,分析不同类型门-腔静脉侧支循环类型的肝脏血流灌注血流参数改变。结果门静脉-上腔静脉分流组,肝血流量(HBF):(115.2±30.8)ml·100ml-1·min-1;肝动脉血流量(HAF):(29.8±21.1)ml·100ml-1·min-1;肝动脉指数(HPI):0.248±0.142;门静脉血流量(PVF):(85.3±23.6)ml·100ml-1·min-1。脾/胃-肾静脉分流组,HBF:(124.6±36.1)ml·100ml-1·min-1;HAF:46.6/29.1ml·100ml-1·min-1;HPI:0.365±0.175;PVF:(77.9±27.2)ml·100ml-1·min-1。门-腔静脉分流术后组,HBF:(101.9±36.5)ml·100ml-1·min-1;HAF:(46.0±21.4)ml·100ml-1·min-1;HPI:0.449±0.183;PVF:(55.8±22.5)ml·100ml-1·min-1。组间差异具有统计学意义,P<0.05。结论肝功能分级和分流方式两个变量对肝血流灌注有独立影响作用。

Influence of portosystemic collateral status on hepatic blood perfusion in cirrhosis with portal hypertension

Objective The purpuse of this study was to evaluate the impact of portosystemic collateral on hepatic blood perfusion in cirrhotic patients by means of CT perfusion scan and multi-slice spiral CT portal venography (CTPV). Methods One hundred and one cases of liver cirrhosis with portal hypertension underwent CT perfusion scan and CTPV. The hepatic perfusion parameters were calculated and analyzed according to type of portosystemic collateral. Results The CT perfusion parameters in patients with portal-SVC collateral were hepatic blood flow (HBF):(115.2±30.8) ml·100 ml^-1·min^-1,hepatic artery flow (HAF):(29.8±21.1) ml·100 ml^-1·min^-1, hepatic perfusion index (HPI):0.248±0.142, portal vein blood flow (PVF):(85.3±23.6) ml·100 ml^-1·min^-1. In patient with spleen/gastric-renal shunt, the CT perfusion parameters were HBF: (124.6±36.1) ml·100 ml^-1·min^-1, HAF: 46.6/29.1 ml·100 ml^-1·min^-1, HPI:0.365/0.175, PVF:(77.9±27.2) ml·100 ml^-1·min^-1. In the cases of operative portosystemic shunt, the CT perfusion parameters were HBF: (101.9±36.5) ml·100 ml^-1·min^-1; HAF:(46.0±21.4) ml·100 ml^-1·min^-1;HPI:0.449±0.183;PVF:(55.8±22.5) ml·100 ml^-1·min^-1. There were statistical significant differences between study groups (P<0.05). Conclusion The liver functional grades and collateral status in cirrhosis patients play an independent effect on CT liver blood perfusion.