CDFI下门脉系统血流动力学改变与肝硬化食管静脉曲张出血的相关性分析  

Correlation between portal venous system hemodynamic changes and esophageal variceal bleeding in cirrhotic patients under CDFI

作　　者：沈晓丽 张超学[1] 马芳[2] 许继梅[2] SHEN Xiao-li;ZHANG Chao-xue;MA Fang;XU Ji-mei(Department of Ultrasound,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Ultrasound,the Second People's Hospital of Hefei,Hefei 2300ll,China)

机构地区：[1]安徽医科大学第一附属医院超声科,安徽合肥230022 [2]合肥市第二人民医院超声科,安徽合肥230011

出　　处：《中国临床医学影像杂志》2023年第2期118-122,126,共6页Journal of China Clinic Medical Imaging

基　　金：安徽省重点研究与开发计划项目(202004j07020031)。

摘　　要：目的:分析彩色多普勒超声(CDFI)下门脉系统血流动力学改变与肝硬化食管静脉曲张出血的相关性。方法:选择2020年1月-2021年12月就诊于我院的94例肝硬化患者作为观察组,另选71例同期健康体检者作为对照组,入院后均通过CDFI测定门脉系统血流动力学(门静脉主干内径(PVD)、血流量(PVQ)、平均血流速度(PVVmean)、充血指数(CI))。根据是否发生肝硬化食管静脉曲张出血将观察组分为出血组、未出血组,按照食管静脉曲张程度分为轻度组、中度组、重度组,对比对照组、观察组及观察组各亚组的门静脉系统血流动力学差异,绘制ROC曲线,分析CDFI下门脉系统血流动力学评估肝硬化食管静脉曲张出血中的效能,经Kendall的tau-b(K)相关性、多项Logistics回归分析食管静脉曲张出血发生与CDFI下门脉系统血流动力学指标的相关性。结果:观察组门静脉系统PVD、PVQ、CI高于对照组,PVVmean低于对照组(P<0.05);出血组门静脉系统PVD、PVQ、CI高于未出血组,PVVmean低于未出血组(P<0.05);门静脉系统PVD、PVQ、CI重度组>中度组>轻度组,PVVmean重度组<中度组<轻度组(P<0.05);绘制ROC曲线,结果显示,PVD、PVQ、CI、PVVmean及四者联合评估肝硬化患者是否发生食管静脉曲张出血的AUC分别为0.832、0.781、0.767、0.832、 0.912, PVD、 PVQ、 CI、 PVVmean的最佳截断值分别为1.345 cm、1 510.162 mL/min、0.086、15.125 cm/s;Kendall的tau-b(K)相关性显示,肝硬化食管静脉曲张出血发生率与PVD、PVQ、CI呈正相关(r=0.613、0.696、0.741,P<0.05),与PVVmean呈负相关(r=-0.698,P<0.05);多项Logistics回归分析结果显示,PVD、PVQ、CI高表达与PVVmean低表达均可能是肝硬化食管静脉曲张出血发生的危险因素(OR>1,P<0.05)。结论:CDFI可准确评估肝硬化患者门静脉高压的血流动力学,CDFI下门脉系统血流动力学改变与食管静脉曲张程度、食管静脉曲张出血发生有关,且各参数联合在肝硬Objective: To analyze the correlation between the hemodynamic changes of portal vein system and esophageal varices bleeding in cirrhosis of liver by CDFI. Methods: A total of 94 patients with liver cirrhosis who were admitted from January 2020 to December 2021 were included as the observation group, and 71 healthy subjects at the same time were selected as the control group. The portal system hemodynamics(PVD, PVQ, PVVmean, and CI) were measured by CDFI after admission. According to the occurrence of esophageal varices, the observation groups were divided into bleeding group and non-bleeding group. According to the degree of esophageal varices, the observation groups were divided into mild, moderate and severe groups. The differences in portal venous system hemodynamics among the control group, the observation group and each subgroup of the observation group were compared, and the ROC curve was drawn. The portal venous system hemodynamics under CDFI was analyzed to evaluate the efficacy of esophageal varices bleeding in cirrhosis. The correlation between esophageal varices bleeding and portal venous system hemodynamics under CDFI was analyzed by Kendall’s tau-b(K) correlation and multiple logistic regression. Results: The PVD, PVQ and CI of the portal vein system in the observation group were higher than those in the control group, and the PVVmean was lower than that in the control group(P<0.05). PVD, PVQ, CI of the portal vein system in the bleeding group were higher than those in the non-bleeding group, and PVVmean was lower than that in the non-bleeding group(P<0.05). PVD, PVQ and CI of portal vein system in severe group>moderate group>mild group,and PVVmean severe group1, (P<0.05). Conclusion: CDFI can accurately evaluate the hemodynamics of portal hypertension in patients with cirrhosis of the liver. The hemodynamic changes of portal system under CDFI are related to the degree of esophageal varices and the occurrence of esophageal variceal bleeding. In addition, the combination of each parameter has high s

关 键 词：肝硬化 食管和胃静脉曲张 超声检查 多普勒 彩色 

分 类 号：R575.2[医药卫生—消化系统] R571.3[医药卫生—内科学] R445.1[医药卫生—临床医学]