超声血流动力学预测移植肝动脉血栓形成及溶栓效果的初步研究  

Preliminary study on predicting hepatic artery thrombosis formation and evaluating treatment efficacy with ultrasound hemodynamic parameters in transplanted liver

作　　者：杨雨辰 朱宇莉 沈文 王文平 徐辉雄 韩红 Yang Yuchen;Zhu Yuli;Shen Wen;Wang Wenping;Xu Huixiong;Han Hong(Department of Ultrasound,Zhongshan Hospital of Fudan University,Shanghai 200032,China;Shanghai Institute of Imaging Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院超声科,上海200032 [2]上海市影像医学研究所,上海200032

出　　处：《中华超声影像学杂志》2024年第2期106-111,共6页Chinese Journal of Ultrasonography

基　　金：上海市卫健委卫生行业临床研究专项面上项目(202340087)。

摘　　要：目的阐明肝移植术后患者移植肝动脉血栓(HAT)发生前及治疗后肝内超声血流动力学变化, 为临床提供HAT预警及抗凝指导。方法回顾性分析2006年6月至2022年10月于复旦大学附属中山医院接受肝移植手术患者的临床资料, 其中47例患者经数字减影血管造影(DSA)确诊为HAT列入血栓组;另纳入71例术后未出现各种血管并发症的移植肝患者为非血栓组。分析两组患者移植肝动脉峰值流速(PSV)、阻力指数(RI)、门静脉流速(PVV)的差异。采用Logistic回归分析确定术后PSV下降与HAT发生的关系, 同时采用ROC曲线确定临界值并评价诊断效能。血栓组患者根据经数次手术取栓或溶栓治疗后血流是否恢复, 分为治疗效果不佳组及治疗效果良好组, 比较两组患者手术或溶栓治疗后早期肝内超声血流动力变化。结果①HAT发生前1 d超声可测及移植肝动脉PSV降低, 以PSV<0.39 m/s预测1 d后即将发生的HAT, 敏感性为0.70, 特异性为0.86, AUC为0.83。②HAT患者治疗后PSV值迅速升高, 治疗后第2 d即可恢复正常(非血栓组)水平;治疗效果良好组治疗后首日PSV及PVV即可达到正常(非血栓组)水平, 明显高于治疗效果不佳组(P=0.030、0.021)。结论肝移植术后早期, PSV<0.39 m/s与1 d后即将发生HAT有关。HAT治疗后首日超声检查发现肝动脉PSV升高显著, 提示治疗效果良好, 无需进一步DSA复查及增加溶栓次数。Objective To clarify the changes of intrahepatic ultrasound hemodynamics before and after hepatic artery thrombosis(HAT)after liver transplantation(LT),providing early warning and anticoagulation guidance to clinicians.Methods The clinical data of patients who underwent liver transplantation at Zhongshan Hospital of Fudan University between June 2006 and October 2022 were retrospectively analyzed,47 patients with a diagnosis of HAT confirmed by DSA(digital subtraction angiography)were included in the HAT group,and 71 patients without vascular complications were included in the non-HAT group.Differences in peak flow velocity(PSV),resistance index(RI),and portal vein velocity(PVV)were compared between the two groups.Logistic regression analysis was used to determine the relationship between postoperative PSV decline and HAT occurrence,while ROC curve were used to determine the critical value and evaluate the diagnostic efficacy.Patients with HAT were divided into well-treatment group and poor-treatment group according to whether the blood flow was restored after multiple surgeries or thrombolytic treatments.The changes of early intrahepatic hemodynamics after surgical or thrombolytic therapy were compared between the two groups.Results①A decrease in PSV of the transplanted hepatic artery was measured 1 d before HAT,and PSV<0.39 m/s predicted thrombus formation with a sensitivity of 0.70,specificity of 0.86,and the AUC was 0.83.②After treatment,PSV in the HAT group increased immediately,approaching the normal level on the 2nd day.In the well-treatment group,PSV and PVV reached normal levels on the first day after treatment,which were significantly higher than the corresponding values in the poor-treatment group(P=0.030,0.021).Conclusions In the early stage after liver transplantation,a PSV<0.39 m/s is related to the occurrence of HAT thrombosis 1 d later.A significant increase in PSV on the first day after treatment indicates a good treatment response,and there is no need for further DSA re-examination or increa

关 键 词：超声检查 肝移植 肝动脉血栓 血流动力学 

分 类 号：R657.3[医药卫生—外科学]