肝超声血流动力学参数评估门静脉高压中重度食管静脉曲张的应用价值  

Evaluation of portal hypertension esophageal varices （moderate to severe ） via liver ultrasound hemodynamic parameters

作　　者：崔亚云[1] 王玲[1] 张超学[1] 闻小林[1] 郑言言[1] 肖蕾[1] 

机构地区：[1]安徽医科大学第一附属医院超声科,合肥230000

出　　处：《中华超声影像学杂志》2013年第9期788-791,共4页Chinese Journal of Ultrasonography

基　　金：安徽省高等学校省级自然科学研究项目（KJ2013A151）

摘　　要：目的运用超声造影及彩色多普勒超声探讨肝超声血流动力学参数在评估门静脉高压患者中重度食管静脉曲张中的价值。方法根据胃镜检查结果，将29例无食管静脉曲张的正常人设为对照组，60例食管静脉曲张的患者分为中重度组（30例）及轻度组（30例），三组分别接受彩色多普勒超声及超声造影检查，采集肝内血流循环动态造影数据，获得时间-强度曲线（TIC曲线），得到以下定量参数：肝静脉减震指数（DI）、门静脉流速（PVV）、造影剂肝动脉到达时间（HAAT）、门静脉到达时间（PVAT）及肝静脉到达时间（HVAT），进而计算造影剂肝静脉肝动脉渡越时间（即造影剂到达肝静脉时间减去到达肝动脉时间，HV—HA），门静脉肝动脉渡越时间（即造影剂到达门静脉时间减去到达肝动脉时间，PV—HA）及门静脉肝静脉渡越时间（即造影剂到达门静脉时间减去到达肝静脉时间，Pv-HV）。应用ROC曲线下面积评价以上参数对诊断中重度食管静脉曲张的价值。结果中重度组PV—Hv、PV—HA、HV-HA、Pvv、DI与对照组比较，差异具统计学意义（P=0．000）；与轻度组比较，PV—HV、PV—HA、Hv_HA、DI差异具统计学意义（P。0．000、尸=0．002、P=0．000、P=0．002），而PVV差异无统计学意义（P〉O．05）。轻度组与对照组比较，PV—HA、HV—HA差异具统计学意义（P=0．028、P=0．024），PV-HV、DI及PVV之间差异无统计学意义（P〉0．05）。PV—HV、PV—HA、HV—HA、PVV、DI的ROC曲线下面积分别为0．952、0．775、0．847、0．699、0．808。以PV—HV≥0．5s为截断值诊断中重度食管静脉曲张的灵敏性、特异性分别为86．2％、94．8％。结论肝超声血流动力学参数评估中重度食管静脉曲张有较高的灵敏性和特异性，有望成为无创诊断中重度食管静脉曲张的新方法。Objective To evaluate the application of liver ultrasound hemodynamic parameters in diagnosing moderate to severe esophageal varices（EV） among patients suffering from portal hypertension. Methods The control group consisted of twenty nine patients without EV. Sixty patients with EV diagnosed by endoscopy were divided into two groups equal in number according to grade of EV. One being mild, the other was moderate to severe. All patients underwent color Doppler flow imaging and contrast- enhanced ultrasound, and the dynamic angiography data were collected. Time-intensity curves were drawn by software to acquire the arrive time of hepatic artery （HAAT）, hepatic vein （HVAT） and portal vein （PVAT）. Then HV-HA interval time,PV-HA interval time and PV-HV interval time were calculated. The quantitative parameters including HV-HA,PV-HA,PV-HV,damping index （DI） of hepatic vein and portal vein velocity（PVV） were compared. ROC curve was used to assess the value of the parameters above in predicting moderate to severe esophageal varices. Results The difference of PV HV, PV-HA, HV-HA, PVV,DI between the control and the moderate to severe group were statistically significant （ P = 0. 000）. PV HV,PV HA,HV-HA,DI in moderate to severe group showed statistically significant compared with mild group （ P = 0. 000, P = 0. 002, P = 0. 000, P = 0. 002） ,however,PVV had no significant （ P 〉0.05） difference between the two groups. Mild group contrasted to the control group, the differences of PV HA and HV-HA were statistically significant （ P = 0. 000）, whereas PV HV, DI, PVV displayed no significant （P〉0.05） difference. The areas under ROC curve of PV-HV, PV-HA,HV-HA,PVV, DI were 0.952, 0. 775,0. 847,0. 699,0. 808 respectively. The best cutoff value of PV HV for diagnosing moderate to severe EV was 0. 5 second, with sensitivity and specificity of 86.2% and 94.8% respectively. Conclusions The liver ultrasound hemodynamic parameters is helpful in the diagnosis and evaluation of moderate to se

关 键 词：超声检查 微气泡 肝 血流动力学现象 食管静脉曲张 

分 类 号：R445.2[医药卫生—影像医学与核医学] R571.3[医药卫生—诊断学]