肝动脉血流阻力指数对非酒精性脂肪性肝病患者进展期肝纤维化的评估价值  

Value of hepatic artery resistance index in evaluating progressive liver fibrosis in nonalcoholic fatty liver disease

作　　者：王诚 陈厚斌[1] 马龙 田泽斌 郑直[1] 周明雄 WANG Cheng;CHEN Houbin;MA Long(Department of Hepatobiliary Surgery,The People′s Hospital of Gong′an County,Gong′an,Hubei 434300,China)

机构地区：[1]湖北省公安县人民医院肝胆外科,湖北公安434300 [2]三峡大学附属仁和医院,湖北宜昌443001

出　　处：《临床肝胆病杂志》2018年第12期2578-2581,共4页Journal of Clinical Hepatology

摘　　要：目的明确非酒精性脂肪性肝病(NAFLD)患者血流相关指数的变化,探讨肝动脉血流阻力指数在进展期肝纤维化中的应用价值。方法选取公安县人民医院2016年1月-2017年12月确诊为NAFLD的患者148例及健康志愿者60例为研究对象,采集空腹静脉血测定肝功能、血常规,计算NAFLD患者的NAFLD纤维化评分(NFS)。按NFS结果将NAFLD患者分为A组(NFS≤0. 676)、B组(NFS>0. 676),以健康人群作为对照组。所有研究对象应用多普勒超声测量肝门静脉峰值(PPVV)、门静脉平均流速(MPVV)及肝动脉血流阻力指数(HARI)。计量资料3组间比较先进行方差分析,若有差异再采用SNK-q法进行多重比较;计数资料组间比较采用χ2检验。采用Spearman秩相关分析不同评价指标间的相关性。结果 148例患者中A组121例,B组27例,HARI值在A组(0. 64±0. 08)、健康对照组(0. 76±0. 09)、B组(0. 88±0. 05)中依次增高,差异有统计学意义(F=4. 981,P <0. 01),MPVV、PPVV在健康人群[(22. 84±3. 12) cm/s、(19. 02±1. 97) cm/s]、A组[(17. 84±2. 87) cm/s、(15. 29±2. 02) cm/s]及B组[(15. 31±2. 29) cm/s、(13. 39±1. 92) cm/s]组中依次降低,差异均有统计学意义(F值分别为5. 645、7. 435,P值均<0. 01)。在NAFLD患者中,HARI与NFS呈正相关(r=0. 763,P <0. 01),MPVV、PPVV与NFS负相关(r值分别为-0. 463、-0. 425,P值均<0. 01)。结论 NAFLD进展期纤维化患者肝血流动力学发生改变,HARI可作为一种无创性方法评价NAFLD患者是否为进展期纤维化,当HARI异常增高时应警惕进展期肝纤维化的发生。Objective To investigate the changes in blood flow indices in patients with nonalcoholic fatty liver disease(NAFLD)and the value of hepatic artery resistance index(HARI)in evaluating progressive liver fibrosis.Methods A total of 148 patients who were diagnosed with NAFLD in The People’s Hospital of Gong′an County from January 2016 to December 2017 and 60 healthy volunteers were selected as study subjects.Fasting venous blood samples were collected for liver function evaluation and routine blood test,and then NAFLD fibrosis score(NFS)was calculated for NAFLD patients.According to NFS,the patients with NAFLD were divided into group A(NFS≤0.676)and group B(NFS>0.676).The healthy volunteers were enrolled as control group.Color Doppler ultrasound was performed to measure peak portal vein velocity(PPVV),mean portal vein velocity(MPVV),and HARI in all subjects.An analysis of variance was used for comparison of continuous data between three groups,and the SNK-q test was used for multiple comparisons;the chi-square test was used for comparison of categorical data between groups.A Spearman′s rank correlation analysis was used to investigate the correlation between assessment indices.Results There were 121 patients in group A and 27 in group B.Group B had the highest HARI(0.88±0.05),followed by the control group(0.76±0.09)and group A(0.64±0.08),and there was a significant difference between groups(F=4.981,P<0.01).The control group had the highest MPVV(22.84±3.12 cm/s)and PPVV(19.02±1.97 cm/s),followed by group A(17.84±2.87 cm/s and 15.29±2.02 cm/s)and group B(15.31±2.29 cm/s and 13.39±1.92 cm/s),and there were significant differences between groups(F=5.645 and 7.435,both P<0.01).In the patients with NAFLD,HARI was positively correlated with NFS(r=0.763,P<0.01),and MPVV and PPVV were negatively correlated with NFS(r=-0.463 and-0.425,both P<0.01).Conclusion There are hemodynamic changes of the liver in NAFLD patients with progressive liver fibrosis.HARI can be used as a noninvasive method to evaluate whether

关 键 词：非酒精性脂肪性肝病 肝硬化 肝动脉 血流动力学 

分 类 号：R575.2[医药卫生—消化系统] R575.5[医药卫生—内科学]