彩色Doppler超声检测门静脉和肝动脉在肝硬化门静脉高压症诊断中的作用  

Value of Doppler ultrasound parameters of portal vein and hepatic artery in the diagnosis of cirrhosis and portal hypertension

作　　者：沈柏用[1] 陈曼[2] 詹维伟[2] 龚启明[3] 彭承宏[1] 李宏为[1] 

机构地区：[1]上海第二医科大学附属瑞金医院普外科,上海市200025 [2]上海第二医科大学附属瑞金医院超声诊断科,上海市200025 [3]上海第二医科大学附属瑞金医院感染科,上海市200025

出　　处：《中华肝胆外科杂志》2006年第4期225-228,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的通过回顾性探讨门静脉和肝动脉的彩色 Doppler 超声检查参数在诊断肝硬化门静脉高压症的敏感性和特异性,并提出在中国人群中上述参数的正常参考值。方法自2001年7月到2004年3月,选取普外科门诊的可疑肝硬化病人和部分正常人群共110例,共有99例完全符合人选标准和检测标准。99例病人全部经肝穿刺活检或手术中取肝组织活检为金标准分为正常组和硬化组,分别测量正常组和硬化组的门静脉流速(PVV)、肝动脉搏动指数(HA-PI)和肝血管指数(LVI),以及上述指标在诊断肝硬化和门静脉高压症的敏感性和特异性,并根据 ROC 曲线推算出上述指标的正常参考值。结果硬化组的 PW 明显低于正常组的 PVV,(11.0±2.5)cm/s vs(16.9±2.9)cm/s,(P<0.001),硬化组的 HA-PI 明显高于正常组的 HA-PI,(1.2±0.2)vs(0.9±0.2),(P<0.001),硬化组的肝脏 LVI 明显低于正常组的 LVI,(9.1±0.6)vs(19.1±1.9),(P<0.001)。PVV为14 cm/s 时诊断肝硬化门静脉高压症的敏感性为91.7%,特异性为91.7%。HA-PI 为1.1时诊断肝硬化门静脉高压症的敏感性为82.6%,特异性为83.3%。LVI 为10时诊断肝硬化门静脉高压症的敏感性为93.8%,特异性为93.8%。结论肝硬化门静脉高压症时门静脉和肝动脉的血流动力学有明显的改变,这种改变反映到彩色 Doppler 超声检查参数以 LVI 诊断的敏感性和特异性最高。Objectives This prospective study was designed to assess the sensitivity and specificity of Doppler ultrasound parameters in the diagnosis of cirrhosis and portal hypertension. Methods From July 2001 to March 2004, portal and hepatic arterial Doppler ultrasound was performed on 99 patients with cirrhosis and controls. The parameters evaluated were portal venous velocity and hepatic arterial pulsatility index. The liver vascular index was calculated as the ratio of portal venous velocity to hepatic arterial pulsatility index. Results Portal venous velocity was significantly lower （11.0±2.5cm/s vs 16.9±2.9cm/s, P〈0.001） and hepatic arterial pulsatility index was significantly higher （1.2±0.2 vs. 9±0.2, P〈0.001） in patients than in controls. Thus, the liver vascular index was significantly lower （9.1±0.6 vs 19.1±1.9, P〈0.001） in patients than in controls. The sensitivity and specificity of these parameters in the detection of cirrhosis and portal hypertension was then analyzed with the receiver operating characteristic curve. The best cut-off values were considered to be 14 cm/s of portal venous velocity and 1.1 of hepatic arterial pulsatility index, showing a sensitivity and specificity of 91.7%, 91.7%, 82.6% and 83.3%, respectively. The best cut-off value of the liver vascular index was 10 cm/s with a sensitivity and specificity of 93.8% and 93.8%, respectively. Conclusions The liver vascular index is a high sensitive and specific Doppler ultrasound parameter in the diagnosis of cirrhosis and portal hypertension.

关 键 词：高血压 门静脉 

分 类 号：R575.2[医药卫生—消化系统]