肝脏渡越时间在门静脉高压-食管胃底静脉曲张患者门静脉压力评估中的应用

doi:10.13481/j.1671-587x.20190132

吉林大学学报(医学版) ›› 2019, Vol. 45 ›› Issue (01): 170-174.doi: 10.13481/j.1671-587x.20190132

• 影像学 • 上一篇

肝脏渡越时间在门静脉高压-食管胃底静脉曲张患者门静脉压力评估中的应用

林元强¹, 姜博², 李鹤群¹, 金春香¹, 王辉¹

1. 吉林大学中日联谊医院超声科, 吉林长春 130033;
2. 吉林大学中日联谊医院南湖院区普通外科, 吉林长春 130012

收稿日期:2018-05-28 发布日期:2019-01-28
通讯作者: 王辉,教授,博士研究生导师(Tel:0431-84995070,E-mail:wanghui19620708@aliyun.com) E-mail:wanghui19620708@aliyun.com
作者简介:林元强(1982-),男,四川省资中县人,主治医师,医学博士,主要从事超声造影及超声介入方面的研究。

Application of hepatic transit time in portal vein pressure assessment in patients with portal hypertension and esophago gastric varices

LIN Yuanqiang¹, JIANG Bo², LI Hequn¹, JIN Chunxiang¹, WANG Hui¹

1. Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun 130033, China;
2. Department of General Surgery, Nanhu Hospital, China-Japan Union Hospital, Jilin University, Changchun 130012, China

Received:2018-05-28 Published:2019-01-28
Contact: 吉林省财政厅吉林省直卫生专项项目资助课题（SCZSY201618）；吉林省科技厅科技发展计划项目资助课题（20170414042G H） E-mail:wanghui19620708@aliyun.com

摘要/Abstract

摘要： 目的：分析肝脏渡越时间与门静脉高压-食管胃底静脉曲张患者门静脉压力的关系，阐明其临床意义。方法：选择因门静脉高压-食管胃底静脉曲张行食管胃底曲张静脉栓塞术患者50例作为观察组，选择无肝病病史及肝病临床表现患者（住院或门诊）50例作为对照组。2组患者均行肝脏超声造影，观察组患者在超声引导下行门静脉穿刺时建立手术通路并测量自由门静脉压（FPP）。比较2组患者肝动脉-肝静脉渡越时间（HA-HVTT）、肝门静脉-肝静脉渡越时间（PV-HVTT）和肝实质-肝静脉渡越时间（PA-HVTT），分析观察组患者HA-HVTT、PV-HVTT、PA-HVTT与FPP的相关性。结果：与对照组比较，观察组患者HA-HVTT、PV-HVTT和PA-HVTT均明显缩短（t=5.078，P<0.01；t=12.163，P<0.01；t=2.649，P<0.01）；观察组患者HA-HVTT、PV-HVTT、PA-HVTT与FPP均呈负相关关系（r=-0.799，P<0.01；r=-0.554，P<0.01；r=-0.735，P<0.01）。HA-HVTT与FPP线性关系为Y=-0.410X+7.254，PV-HVTT与FPP线性关系为Y=-0.355X+4.983，PA-HVTT与FPP线性关系为Y=-0.566X+4.997。结论：肝脏渡越时间可以成为判断门静脉压力的有效指标，为门静脉高压患者的诊断和治疗提供理论依据。

关键词: 肝硬化, 食管胃底静脉曲张, 超声造影, 渡越时间, 门静脉压力

Abstract: Objective: To analyze the relationship of hepatic transit time and portal vein pressure in the patients with portal hypertension and esophagogastric varices, and to clarify its clinical significance.Methods: A total of 50 hospitalized patients underwent esophagogastric venous embolization due to portal hypertension and esophagogastric varices were selected as observation group, and 50 patients without history of liver disease and clinical manifestations of liver disease (hospitalized or out-patient) were selected as control group, All patients underwent liver contrast enhanced ultrasound.The free portal pressure (FPP)was measured by ultrasound guided portal vein puncture for operating pathways in the patients in observation group. The hepatic artery-hepatic vein transit time (HA-HVTT), the hepatic portal vein-hepatic vein transit time (PV-HVTT), the liver parenchyma-hepatic vein transit time (PA-HVTT) of the patients were compared between two groups. The correlations between HA-HVTT, PV-HVTT, PA-HVTT and FPP of the patients in observation group were analyzed.Results: The HA-HVTT, PV-HVTT and PA-HVTT of the patients in observation group were significantly shorter than those in control group(t=5.078,P<0.01;t=12.163,P<0.01;t=2.649,P<0.01).The HA-HVTT, PV-HVTT and PA-HVTT had negative correlations with FPP in observation group(r=-0.799,P<0.01;r=-0.554,P<0.01;r=-0.735, P<0.01).The linear relationship between HA-HVTT and FPP was Y=-0.410X+7.254; the linear relationship between PV-HVTT and FPP was Y=-0.355X+4.983; the linear relationship between PA-HVTT and FPP was Y=-0.566X+4.997.Conclusion: Liver transit time can be used as an effective index to judge the portal vein pressure, and it can provide the theroretical basis for the diagnosis and treatment of portal hypertension in the patients.

Key words: cirrhosis, esophagogastric varices, contrast enhanced ultrasound, transit time, portal pressure

中图分类号:

R445.1

林元强, 姜博, 李鹤群, 金春香, 王辉. 肝脏渡越时间在门静脉高压-食管胃底静脉曲张患者门静脉压力评估中的应用[J]. 吉林大学学报(医学版), 2019, 45(01): 170-174.

LIN Yuanqiang, JIANG Bo, LI Hequn, JIN Chunxiang, WANG Hui. Application of hepatic transit time in portal vein pressure assessment in patients with portal hypertension and esophago gastric varices[J]. Journal of Jilin University(Medicine Edition), 2019, 45(01): 170-174.

参考文献

[1] SIRLI R,SPOREA I,POPESCU A,et al. Ultrasound-based elastography for the diagnosis of portal hypertension in cirrhotics[J]. World J Gastroenterol,2015,21(41):11542-11551.
[2] THABUT D,MOREAU R,LEBREC D. Noninvasive assessment of portal hypertension in patients with cirrhosis[J]. Hepatology, 2011,53(2):683-694.
[3] ADDLEY J,THAM T C,CASH W J. Use of portal pressure studies in the management of variceal haemorrhage[J]. World J Gastrointest Endosc, 2012, 4(7):281-289.
[4] RINCON D,LOIACONO O,TEJEDOR M,et al. Prognostic value of hepatic venous pressure gradient in patients with compensated chronic hepatitis C-related cirrhosis[J]. Scand Gastroenterol,2013,48(4):487-495.
[5] QIU L,ZHANG X,LIU D, et al. Contrast-enhanced ultrasonography diagnostic evaluation of esophageal varices in patients with cirrhosis[J]. Ultrasound Q,2016,32(2):136-143.
[6] KIM M Y,SUK K T,BAIK S K,et al. Hepatic vein arrival time as assessed by contrast-enhanced ultrasonography is useful for the assessment of portal hypertension in compensated cirrhosis[J]. Hepatology, 2012,56(3):1053-1062.
[7] TAVANGAR S M,NASER RAKHSHANI N,GHODRAT MONTAZERI,et al.The effect of NAFLD(non-alcoholic fatty liver disease)on long-term outcome of chronic hepatitis B in Iranian patients[J].Open J Gastroenterol,2012,2(1):218-221.
[8] GOBEL T,ERHARDT A,HERWIG M,et al. High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe[J]. JMed Virol,2011, 83(6):968-973.
[9] BOLOGNESI M,PASCOLI M D,SACERDOTI D. Clinical role of non-invasive assessment of portal hypertension[J]. World J Gastroenterol, 2017, 23(1):1-10.
[10] KOLLER T,PIESTANSKA Z,HLAVATY T, et al. Hepatic transit times and liver elasticity compared with meld in predicting a 1 year adverse clinical outcome of a clinically diagnosed cirrhosis[J]. Vnitr Lek,2016,62(5):351-359.
[11] KUMAR A,SHARMA P,SARIN S K. Hepatic venous pressure gradient measurement:time to learn![J]. Indian J Gastroenterol,2008,27(2):74-80.
[12] RIPOLL C,GROSZMANN R,GARCIA-TSAO G,et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis[J]. Gastroenterology,2007,133(2):481-488.
[13] WANG T, LIANG F, ZHOU Z,et al. Global sensitivity analysis of hepatic venous pressure gradient (HVPG) measurement with a stochastic computational model of the hepatic circulation[J]. Comp Biol Med, 2018, 97(1):124-136.
[14] BERZIGOTTI A,PISCAGLIA E.Ultrasound in portal hypertension-part2-and EFSUMB recommendations for the performance and reporting of ultrasound examinations in portal hypertension[J].Ultraschall Med,2012,33(1):8-32.
[15] ABBATTISTA T,RIDOLFI F,CONSALVO G T,et al. Hepatic vein arrival time for diagnosis of liver cirrhosis:A 10-year single-center experience with contrast-enhanced sonography[J]. J Ultrasound Med, 2016,35(10):2121-2128.
[16] MARUYAMA H,YOKOSUKA O. Ultrasonography for noninvasive assessment of portal hypertension[J]. Gut Liver,2017, 11(4):464-473.
[17] MARUYAMA H,SHIHA G,YOKOSUKA O,et al. Non-invasive assessment of portal hypertension and liver fibrosis using contrast-enhanced ultrasonography[J]. Hepatol Int,2016,10(2):267-276.
[18] GARCIA-TSAO G,SANYAL A J, GRACE N D,et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J]. Hepatology,2007,46(3):922-938.
[19] GARCÍA-PAGÁN J C,GRACIA-SANCHO J,BOSCH J. Functional aspects on the pathophysiology of portal hypertension in cirrhosis[J]. J Hepatol,2012,57(2):458-461.
[20] ZHANG C X, HU J,HU K W,et al. Noninvasive analysis of portal pressure by contrast-enhanced sonography in patients with cirrhosis[J]. J Ultrasound Med,2011,30(2):205-211.
[21] LUISA S,VITALE G,SORBO A R,et al. Hepatic vein transit time of second-generation ultrasound contrast agent:new tool in the assessment of portal hypertension[J]. J Ultrasound,2017, 20(1):43-52.
[22] ABBATTISTA T,RIDOLFI F,CIABATTONI E, et al. Diagnosis of liver cirrhosis by transit-time analysis at contrast-enhanced ultrasonography[J]. Radio Med,2008,113(6):860-874.

肝脏渡越时间在门静脉高压-食管胃底静脉曲张患者门静脉压力评估中的应用

Application of hepatic transit time in portal vein pressure assessment in patients with portal hypertension and esophago gastric varices

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