常规超声与超声造影定量评估肝硬化门静脉高压患者经颈静脉肝内门体静脉支架分流术后疗效的对比研究  

Comparative study of conventional ultrasound and contrast-enhanced ultrasound in quantitative evaluation of the efficacy of transjugular intrahepatic portosystemic shunt in patients with cirrhotic portal hypertension

作　　者：李瑛琪 丁琳茹 LI Yingqi;DING Linru(Department of Ultrasound Medicine,Yuncheng Central Hospital Affiliated to Shanxi Medical University,Shanxi 044000,China)

机构地区：[1]山西医科大学附属运城市中心医院超声医学科,山西省运城市044000

出　　处：《临床超声医学杂志》2024年第6期480-484,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用常规超声与超声造影(CEUS)定量评估肝硬化门静脉高压(PHT)患者经颈静脉肝内门体静脉支架分流术(TIPS)后疗效,对比分析其临床价值。方法选取在我院接受TIPS治疗的PHT患者85例,均于TIPS前1 d及TIPS后1个月行常规超声检查和CEUS检查,获取门静脉内径(PVD)、脾静脉内径(SVD)、肠系膜上静脉内径(SMVD)、门静脉血流速度(PVV)、脾静脉血流速度(SVV)、肠系膜上静脉血流速度(SMVV),以及到达时间(AT)、达峰时间(TTP)、峰值强度(PI)、上升支斜率(AS);依据指南推荐方法检测TIPS前后门静脉压力梯度(PPG);比较PHT患者上述参数的差异。采用Pearson相关分析法分析PHT患者TIPS前常规超声及CEUS定量参数与TIPS后PPG的关系。结果常规超声检查结果显示,PHT患者TIPS前后PVD、SVD、SMVD、PVV、SVV、SMVV比较,差异均无统计学意义;CEUS检查结果显示,PHT患者TIPS后AT、TTP均较TIPS前缩短,PI、AS均较TIPS前增高,差异均有统计学意义(均P<0.05)。PHT患者TIPS前后PPG分别为(31.76±6.28)mmHg(1 mmHg=0.133 kPa)、(13.42±2.03)mmHg,差异有统计学意义(t=25.619,P<0.05)。Pearson相关性分析显示,PHT患者TIPS前AT、TTP与TIPS后PPG均呈正相关(均P<0.05),PI、AS与TIPS后PPG均呈负相关(均P<0.05);PHT患者TIPS前常规超声参数PVV、SVV、SMVV、PVD、SVD、SMVD与TIPS后PPG均无相关性。结论CEUS较常规超声可更准确地定量评估PHT患者TIPS前后门静脉压力变化,在TIPS后短期疗效评估中具有较好的临床价值。Objective To quantitatively evaluate the efficacy of transjugular intrahepatic portosystemic shunt(TIPS)in patients with cirrhotic portal hypertension(PHT)by conventional ultrasound and contrast-enhanced ultrasound(CEUS),and to compare and analyze the clinical value.Methods A total of 85 cases of PHT patients treated with TIPS in our hospital were selected.All patients underwent conventional ultrasound examination and CEUS examination 1 d before TIPS and 1 month after TIPS.The portal vein diameter(PVD),splenic vein diameter(SVD),superior mesenteric vein diameter(SMVD),portal vein flow velocity(PVV),splenic vein flow velocity(SVV),superior mesenteric vein flow velocity(SMVV),arrival time(AT),time to peak(TTP),peak intensity(PI),ascending branch slope(AS)before and after TIPS were obtained.The portosystemic pressure gradient(PPG)measured by guideline recommendation before and after TIPS was obtained.The differences of the above parameters before and after TIPS in PHT patients were compared.Pearson correlation analysis was used to analyze the relationship between conventional ultrasound and CEUS parameters before TIPS and PPG after TIPS in PHT patients.Results Conventional ultrasound showed that there were no significant difference in PVD,SVD,SMVD,PVV,SVV,SMVV before and after TIPS in PHT patients.CEUS showed that AT and TTP of PHT patients after TIPS were shorter than those before TIPS,while PI and AS were higher than those before TIPS,with statistically significant differences(all P<0.05).The PPG of PHT patients before and after TIPS were(31.76±6.28)mmHg(1 mmHg=0.133 kPa)and(13.42±2.03)mmHg,respectively,and the difference was statistically significant(t=25.619,P<0.05).Pearson correlation analysis showed that AT and TTP before TIPS were positively correlated with PPG after TIPS(both P<0.05),while PI and AS were negatively correlated with PPG after TIPS(both P<0.05).Conclusion Compared with conventional ultrasound,CEUS could better quantitatively evaluate the changes of portal vein pressure in PHT patients before

关 键 词：超声检查 造影剂 肝硬化 门静脉高压 经颈静脉肝内门体静脉支架分流术 短期疗效 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575.2[医药卫生—诊断学]