超声检测肝硬化患者肝动脉多普勒血流灌注指数动态变化的临床意义  

The clinical value of ultrasonographic measurement of dynamic changes of hepatic artery Doppler perfusion index in patients with liver cirrhosis

作　　者：董磊[1] 陆建明[1] 钱孝纲[1] 邵明焕[1] 叶萍[1] 

机构地区：[1]215500,江苏省,常熟市第二人民医院功能科

出　　处：《中华医学超声杂志（电子版）》2005年第4期224-227,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨肝动脉多普勒血流灌注指数(DPI)的动态变化对肝癌易感人群的随访价值.方法对180例肝硬化患者随访时行超声、血清AFP等检查,必要者行CT检查.超声检测参数主要有肝动脉DPI、肝动脉DPI增加值的百分比(DPI%)、肝动脉血流量(Qa)及肝静脉血流量(Qv),并对随访结果及肝癌诊断时间进行比较分析.结果(1)180例肝硬化患者随访中临床诊断肝癌51例,其中37例为单一肿块型,9例为两枚肿块型,5例为弥漫型,肿块直径为1.3～2.7 cm,平均(2.0±0.5)cm;(2)51例肝癌患者肝动脉DPI初检至发现肝癌时均有1次显著性升高,若以DPI%＞26.4%作为判定肝硬化患者发现肝癌的标准,其敏感性、特异性、阳性预测值均为100%,肝动脉DPI诊断肝癌的时间比常规超声诊断肝癌的时间提前(37.6±12.7)d;(3)肝动脉DPI值与肿块数量有关,弥漫型肝癌最高,并与肿块直径及体积大小呈正相关(分别为r=0.352,P=0.0476;r=0.359,P=0.0423),但随肿块体积增大肝动脉DPI升高程度差异无统计学意义(P＞0.05).结论在肝癌易感人群的随访中,肝动脉DPI值的显著性升高是诊断肝癌的可靠参数,与其他检查方法结合可将临床诊断肝癌的时间提前.Objective To investigate the dynamic changes of hepatic artery Doppler perfusion index （DPI） by ultrasonographic measurement in liver cirrhosis patients and to evaluate its significance for follow-up of the population susceptible to hepatic carcinoma. Methods A total of 180 patients with liver cirrhosis underwent ultrasonography and serum AFP test during follow-up; and CT examination was performed in some of them if necessary. The ultrasonographic parameters included hepatic artery DPI, the percentage of increase in hepatic artery DPI （ DPI % ）, hepatic artery blood flow （Qa） and hepatic vein blood flow （Qv）. The time of diagnosing hepatic carcinoma by routine ultrasonography, AFP, CT, DPI or clinical diagnosis was compared; and the follow-up results were also compared among these examinations. Results （ 1 ） Of the 180 patients with liver cirrhosis, 51 were clinically diagnosed with hepatic carcinoma during follow-up. In these 51 patients, 37 had one lump, 9 had 2 lumps, and 5 had diffuse tiny lumps, with lump diameter ranging from 1.3 to 2.7 cm （mean, 2.0 ± 0.5 cm） ; （2）All the 51 patients with hepatic carcinoma experienced one-time significant increase in DPI from the initial examination to detection of hepatic carcinoma. If DPI% 〉 26.4% was taken as the criterion for finding the liver cirrhosis patients to have hepatic carcinoma, the sensitivity, specificity and positive predictive value were all 100%. The time of significant increase in DPI was earlier than the time of clinical diagnosis of hepatic carcinoma （ mean 33.8 days ahead） ; （3） DPI was associated with the lump number of hepatic carcinoma and was highest in the hepatic carcinoma patients with diffuse tiny lumps. There was a positive correlation between DPI and lump diameter （ r = 0. 352, P = 0. 0476） or lump volume （ r = 0. 359, P = 0. 0423）, but the advancing degree of DPI with increase in lump volume was not statistically significant （ P 〉 0.05 ）. Conclusions The significant increase in hepatic a

关 键 词：超声检查 肝硬化 肝动脉 肝肿瘤 随访研究 肝动脉血流量 肝硬化患者 血流灌注指数 超声检测 动态变化 

分 类 号：R657.34[医药卫生—外科学] R575.2[医药卫生—临床医学]