小儿肝移植术后门静脉吻合口狭窄的诊断:多普勒超声与血管腔内测压的对照研究  

Pediatric liver transplant portal vein anastomotic stenosis:a comparative study between Doppler ultrasound and intravascular manometry

作　　者：张国英[1] 唐缨[1] 牛宁宁[1] 武红涛[1] 于慧敏[1] 王明阳 孔维娜 Zhang Guoying;Tang Ying;Niu Ningning;Wu Hongtao;Yu Huimin;Wang Mingyang;Kong Weina(Department of Ultrasound,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院超声科,天津300192

出　　处：《中华超声影像学杂志》2022年第9期785-790,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82172031);天津市卫健委科技项目(KJ20078)。

摘　　要：目的探讨肝移植患儿门静脉多普勒超声参数与压力梯度的相关性,并分析其诊断门静脉吻合口狭窄的价值。方法对2014年6月至2021年9月于天津市第一中心医院儿童肝移植科就诊的92例肝移植患儿的100次门静脉测压结果及超声参数进行回顾性分析。收集的超声参数包括门静脉供体侧、吻合口及受体侧的直径及流速,吻合口狭窄率=(受体侧直径-吻合口直径)/受体侧直径×100%,流速比=吻合口流速/受体侧流速,流速差=吻合口流速-受体侧流速。依据门静脉测压诊断门静脉狭窄的标准分组,供受体两端压力差>5 mmHg为狭窄组,≤5 mmHg为非狭窄组,分析超声各参数与压力差的相关性,并比较两组间超声参数的差异,ROC曲线评价各参数的诊断效能。结果①相关性分析:压力差与吻合口流速、流速差、流速比呈正相关(r=0.521、0.531、0.417,均P<0.001),与吻合口直径呈负相关(r=-0.284,P=0.004),与供体侧直径、供体侧流速、受体侧直径、受体侧流速及直径狭窄率无明显相关性(均P>0.05)。②差异性比较:狭窄组门静脉吻合口流速、流速差及流速比明显高于非狭窄组门静脉吻合口流速、流速差及流速比,差异有统计学意义[135.5(111.0,169.0)cm/s比103.7(72.9,118.7)cm/s,(112.2±40.3)cm/s比(67.9±30.5)cm/s,5.56(3.73,7.26)比3.85(2.78,4.70);均P≤0.001],其余参数两组之间比较差异无统计学意义(均P>0.05)。③经ROC曲线分析,各参数诊断门静脉狭窄的截断值、曲线下面积、最大约登指数、准确性、敏感性、特异性分别为:吻合口流速124.5 cm/s、0.814、0.592、80.0%、65.5%、93.7%;流速比5.67、0.760、0.488、73.0%、48.8%、100%;流速差107.25 cm/s、0.797、0.511、76.0%、51.9%、100%。结论肝移植患儿门静脉吻合口流速、流速差和流速比与供受体两端压力差具有相关性,且各参数诊断门静脉狭窄的准确性及特异度均较高,敏感性略低。Objective To investigate the correlation between Doppler ultrasound parameters and pressure gradient of portal vein in pediatric liver transplant patients,and to analyze the diagnostic value of Doppler ultrasound for portal vein stenosis.Methods This retrospective study involved the data from 92 pediatric liver transplant patients in Tianjin First Central Hospital from June 2014 to September 2021,who underwent pressure gradient measurement.The collected ultrasonic parameters included the diameter and flow velocity of the native portal vein,the portal vein anastomosis,and the donor portal vein.The anastomotic stenosis rate=(the native portal vein diameter–the portal vein anastomosis diameter)/the native portal vein diameter,the velocity ratio=the portal vein anastomosis velocity/the native portal vein velocity,the velocity difference=the portal vein anastomosis velocity–the native portal vein velocity.According to the diagnostic standard of portal vein stenosis,pressure gradient more than 5 mmHg was the portal vein stenosis group,and the pressure gradient less than 5 mmHg was the non-stenosis group.The correlation and differences between ultrasonic parameters and pressure gradient were analyzed.ROC curve was used to evaluate the diagnostic efficiency of each parameter.Results Firstly,there was a positive correlation between pressure gradient and the portal vein anastomosis velocity,the velocity difference and the velocity ratio(r=0.521,0.531,0.417;all P<0.001).And there was a negative correlation between pressure gradient and the anastomotic diameter(r=-0.284,P=0.004).Secondly,the portal vein anastomotic velocity,velocity difference and velocity ratio in stenosis group were significantly higher than those in non-stenosis group[135.5(111.0,169.0)cm/s vs 103.7(72.9,118.7)cm/s,(112.2±40.3)cm/s vs(67.9±30.5)cm/s,5.56(3.73,7.26)vs 3.85(2.78,4.70);all P≤0.001];Furthermore,by ROC curve analysis,the cut-off value,the area under the ROC curve,Jordan index,accuracy,sensitivity and specificity of each parameter for t

关 键 词：超声检查 儿童肝移植 门静脉吻合口狭窄 压力梯度 

分 类 号：R726.5[医药卫生—儿科]