肝静脉彩色多普勒血流频谱在肝纤维化分期中的临床价值

肝脏 ›› 2023, Vol. 28 ›› Issue (8): 907-911.

肝静脉彩色多普勒血流频谱在肝纤维化分期中的临床价值

陈勇良, 赵辉, 王晓静, 李秋雨, 潘丽, 李振燕

050021 河北石家庄市第五医院感染科(陈勇良,王晓静,李秋雨,潘丽),功能科(赵辉,李振燕)

收稿日期:2022-09-28 出版日期:2023-08-31 发布日期:2023-09-21
通讯作者: 李振燕,Email:swycsl@163.com
基金资助:
石家庄市科学技术研究与发展计划(201201243);河北省医学科学研究课题计划(20221689)

Clinical utility of color Doppler flow spectrum of hepatic vein for liver fibrosis staging

CHEN Yong-liang¹, ZHAO Hui², WANG Xiao-jing¹, LI Qiu-yu¹, PAN Li¹, LI Zhen-yan²

1. Department of Infectious Disease, Shijiazhuang Fifth Hospital, Hebei 050021, China;
2. Functional Section, Shijiazhuang Fifth Hospital, Hebei 050021, China

Received:2022-09-28 Online:2023-08-31 Published:2023-09-21
Contact: LI Zhen-yan,Email:swycsl@163.com

摘要/Abstract

摘要： 目的探讨肝左静脉、肝中静脉、肝右静脉彩色多普勒血流频谱在诊断肝纤维化分期中的应用价值。方法应用彩色多普勒超声检测344例慢性肝炎患者的肝左静脉、肝中静脉及肝右静脉频谱波形,全部病例均行肝组织穿刺活检病理诊断,将获得肝静脉频谱波形与肝纤维化分期进行对照分析。结果 344例患者肝静脉频谱波形分为:双向波型(O型)、单向波型(Ⅰ型)、连续平坦型(Ⅱ型);按肝纤维化程度分为轻度(S0~S1)、中度(S2~S3)和重度(S4)三组。肝左静脉、肝中静脉、肝右静脉O、Ⅰ、Ⅱ波型与轻、中、重度三组间构成比差异有统计学意义(χ²=30.090、29.447、15.572,P<0.001)。肝左静脉O型波、Ⅱ型波与肝纤维化分期比较差异有统计学意义(r=-0.268、0.194,P<0.001)。肝中静脉O型波、Ⅰ型波、Ⅱ型波与肝纤维化分期比较差异有统计学意义(r=-0.268、0.108、0.154,P<0.001、<0.05、<0.05)。肝右静脉O型波、Ⅱ型波与肝纤维化分期比较差异有统计学意义(r=-0.198、0.147,P<0.001、<0.05)。结论肝左静脉、肝中静脉、肝右静脉三支肝静脉彩色多普勒血流频谱均可较好地反映肝纤维化程度,其中肝中静脉频谱较肝左静脉及肝右静脉作为评估指标更可靠。

关键词: 肝脏血流动力学, 肝静脉, 彩色多普勒频谱, 超声检查, 肝纤维化分期

Abstract: Objective To investigate the value of color Doppler flow spectrum of left, middle and right hepatic veins in staging liver fibrosis.Methods In this study, Color Doppler ultrasound was used to record the spectral waveforms of the left, middle, and right hepatic veins in 344 patients with chronic hepatitis. All patients were subjected to a pathological liver biopsy for diagnosis, and the spectral waveforms obtained from the hepatic veins were subsequently compared with the liver fibrosis staging.Results The 344 patients with spectral waveforms of the hepatic vein were divided into three types: bi-direction wave(type O), uni-direction wave( type I), and continuous flat wave (type II). According to the degree of liver fibrosis, patients were also grouped into mild (S0~S1), moderate (S2~S3) and severe (S4) categories. The composition ratio of the left, middle and right hepatic veins exhibiting Type O, Ⅰ and Ⅱ waves, across the mild, moderate, and severe groups, showed significant differences with χ²=30.090, 29.447, 15.572, P<0.001. The correlation between the liver fibrosis stage and type O and type Ⅱ waves of the left hepatic vein was statistical significance(r=-0.268, 0.194, P<0.001). The correlation between the liver fibrosis stage and type O, type Ⅰ and type Ⅱ waves of the middle hepatic vein was also significant(r=-0.268, 0.108, 0.154, P<0.001, <0.05, <0.05). Moreover, the correlation between the liver fibrosis stage and, type O and type Ⅱ waves of the right hepatic vein was significant(r=-0.198, 0.147, P<0.001, <0.05).Conclusion The color Doppler blood flow spectrum from three hepatic veins-left , middle and right-proved a comprehensive reflection of the liver fibrosis degree. Moreover, the spectral readings from the middle hepatic vein appears to be more reliable than those from the left and right hepatic veins when used as an evaluation index.

Key words: Hepatic hemodynamics, Portal vein, Color Doppler spectrum, Ultrasonic examination, Staging of liver fibrosis

陈勇良, 赵辉, 王晓静, 李秋雨, 潘丽, 李振燕. 肝静脉彩色多普勒血流频谱在肝纤维化分期中的临床价值[J]. 肝脏, 2023, 28(8): 907-911.

CHEN Yong-liang, ZHAO Hui, WANG Xiao-jing, LI Qiu-yu, PAN Li, LI Zhen-yan. Clinical utility of color Doppler flow spectrum of hepatic vein for liver fibrosis staging[J]. Chinese Hepatolgy, 2023, 28(8): 907-911.

参考文献

[1] Bosch J, Abraldes J, Berzigotti A, et al. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol, 2009,6(10):573-582.
[2] Qi X, Berzigotti A, C ardenas A, et al. Emerging non-invasive approaches for diagnosis and monitoring of portal hypertension. Lancet Gastroenterol Hepatol,2018,3(10):708-719.
[3] Campana L, Iredale, J. Regression of liver fibrosis. Semin Liver Dis,2017,37(1):1-10.
[4] Marcellin P, Gane,E, Buti M, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet,2013,381(9865):468-475.
[5] 中华医学会肝病学分会, 等. 肝纤维化诊断及治疗共识(2019年). 临床肝胆病杂志,2019,35(10):2163-1-2192.
[6] 李越, 李鹏, 张月宁, 等. 肝静脉压力梯度指导的肝硬化门静脉高压症诊治策略:梦想?现实?. 中华肝脏病杂志,2018,26(4):254-258.
[7] D'Amico G, Morabito A, D'Amico M, et al. New concepts on the clinical course and stratification of compensated and decompensated cirrhosis. Hepatol Int,2017,7(5):1-10.
[8] 孟海生, 胡冬梅, 李莎莎, 等. 超声量化指标与肝静脉波形分型在评价乙肝患者肝纤维化程度中的临床意义. 中国超声医学杂志,2021,37(1):59-62.
[9] 张洪, 张佳, 周家龙, 等. 肝静脉直径、改良肝尾叶/右叶比值对肝纤维化和肝硬化病理学分期的诊断价值. 中国医学影像学志,2020,28(7):529-534
[10] 张胜林, 王焕侠, 刘翠. 等, 超声二维量化指标及肝静脉波形分型在慢性乙型肝炎肝纤维化程度评估中的应用. 蚌埠医学院学报,2016.41(6):791-792,796.
[11] 孟繁坤, 郑颖, 葛辉玉, 等. 慢性肝炎肝静脉彩色多普勒超声频谱改变与肝纤维化分期相关性的研究. 中华超声影像学杂志,2006,15(4):298-299.
[12] 刘平,高云华, 谭开彬, 等. 肝静脉流速曲线波型与肝纤维化关系的实验研究. 中华超声影像学杂志,2008,12(9):552-554.
[13] 许晓勇, 张超学, 时晨, 等. 抗病毒治疗对乙型肝炎肝硬化患者肝脏血流动力学的影响. 中华消化杂志,2015,35(9):632-635.
[14] Weiskirchen R. Hepatoprotective and anti-fibrotic agents: It's time to take the next step. Front Pharmacol,2015,6:303.
[15] Tacke F, Weiskirchen R. An update on the recent advances in antifibrotic therapy. Expert Rev Gastroenterol Hepatol,2018,12(11):1143-1152.
[16] 陈曼, 詹维伟, 周建桥, 等. 肝静脉频谱波形分析对肝纤维化的临床价值研究. 中国超声医学杂志,2008,24(1):41-43.