摘要
目的探讨超声检测肝硬化脾脏自发性血液分流与门静脉血流动力学变化之间的关系。方法87例患者分为慢性肝炎组、肝硬化组、对照组;根据Child-Pugh分级标准将肝硬化患者肝脏功能分为ChildA组和ChildB/C组。静息状态下分别测量肝动脉、门静脉、肠系膜上动静脉、脾动静脉等血管的血流动力学参数,分别计算脾静脉、肠系膜上静脉分流率;脾静脉、肠系膜上静脉与门静脉血流量比值,以及各试验组患者的肝循环指数。分析脾脏自发性血液分流对门静脉血流动力学的影响以及与肝循环指数之间的关系。结果门静脉血流量各试验组间差异无统计学意义,但肝硬化组脾静脉血流量明显增加,与对照组和慢性肝炎组比较差异有统计学意义;肝硬化组脾静脉与门静脉血流量比值大于1,脾静脉分流率肝硬化组与对照组和慢性肝炎组比较差异有统计学意义。肝功能ChildB/C级组脾静脉分流率明显大于ChildA级组,脾静脉所占门静脉血流量比值随着肝脏功能的减低而增加,肠系膜上静脉所占门静脉血流量比值逐渐减低,脾静脉与肠系膜上静脉血流量比值增加。脾静脉血流量占门静脉血流量比值与肝循环指数之间呈非线性负相关。结论脾脏自发性血液分流与脾脏高动力循环互相影响,同时对于肝脏的血流灌注有重要作用,检测Vspv/Vpv比值可初步判定肝硬化患者的肝脏储备功能。
Objective To investigate the effect of spleen spontaneous shunt on portal vein hemodynamics in patients with liver cirrhosis with Doppler ultrasound.Methods Eighty-seven patients were divided into chronic hepatitis group,liver cirrhosis group and control group.Liver function of cirrhosis patients was classified into Child A and Child B/C according to Child-Pugh categorization criteria.Hemodynamic parameters of hepatic artery,portal vein,superior mesenteric artery/vein and spleen artery/vein were examined on resting condition.Then the blood shunt ratio of spleen vein and superior mesenteric vein with portal vein,as well as hepatic circulation index（HCI）were calculated.The relationship between spleen blood shunt and HCI was analyzed.Results Portal vein blood flow was not significantly different among groups.Spleen vein blood flow increased in cirrhosis group,which was significantly different to that of control group and chronic hepatitis group.The spleen shunt ratio of cirrhosis group was greater than that of control group and chronic hepatitis group,as well as the Child B/C and Child A in cirrhosis group;the ratio of spleen vein flow to portal vein flow and spleen vein flow to superior mesenteric vein flow increased,but the ratio of superior mesenteric vein flow to portal vein flow decreased with the liver function decreased in cirrhosis group.There was non-linear negative correlation between HCI and the spleen shunt ratio.Conclusion Spleen spontaneous shunt and splenic hyperdynamic circulation play an important role in liver perfusion.Detecting V spv /V pv ratio with Doppler ultrasound in patients with liver cirrhosis is helpful in assessing liver function reserve.
出处
《中国医学影像技术》
CSCD
北大核心
2010年第1期96-98,共3页
Chinese Journal of Medical Imaging Technology
关键词
肝硬化
血流动力学
肝脏功能
肝循环指数
Liver cirrhosis
Hemodynamics
Liver function
Hepatic circulation index
作者简介
杨一林（1966-），男，甘肃临洮人，博士，副主任医师、副教授。研究方向：腹部及浅表器官超声诊断。[通讯作者]杨一林，第四军医大学唐都医院超声科，710038。E—mail：yangyl66@126．com
