二维超声和彩色多普勒血流显像对乙型肝炎肝纤维化的诊断价值

摘要

Objective To explore diagnostic value of color Doppler Ultrasonography for liver fibrosis in patients with hepatitis B Methods Two hundred and two patients with hepatitis B from Jan.2008 to Dec.2011 were divided into S0,S1,S2 and S3 group according to pathologic diagnosis of their liver biopsy specimens.The blood flow of the portal vein was determined in patients with liver fibrosis by color Doppler Ultrasonography.Results Compared with S0,the interior diameter of portal vein (Dpv),splenic vein (Dsv)and mesenteric vein (Dsmv)in S1,S2 and S3 group significantly enhanced [ (1.48±0.19),(1.52±0.25 ),(1.98±0.26)cm vs (1.05±0.22)cm;(1.17±0.25),(1.38±0.31),(1.62±0.34)cm vs (0.81±0.24)cm;(1.28±0.25),(1.65±0.61),(1.87±0.57)cm vs (0.99±0.21 )cm],the velocity of portal vein(Vpv)and mesenteric vein(Vsmv)in S1,S2and S3 group significantly reduced [ (18±5 ),(14±4),(12±4)cm/s vs (25±5 )c m/s;(20±6 ),(17±7 ),(14±7)cm/s vs (32±7)cm/s],the velocity of splenic vein (Vsv)in S1,S2 and S3 group significantly increased (P ＜0.05),the quantity of portal vein (Qpv)and splenic vein (Qpv)in S1,S2 and S3 group significantly increased (P＜0.05 ),but the quantity of mesenteric vein in S1,S2 and S3 group significantly reduced (P＜0.05 ).With the increase of the degree of above index,liver fibrosis in patients also increased.Conclusion Color Doppler ultrasound plays an important value in diagnosing liver fibrosis of hepatitis.%目的 探讨二维超声和彩色多普勒血流显像对乙型肝炎肝纤维化的临床诊断意义.方法 将202例慢性乙型肝炎肝纤维化患者按照肝脏穿刺活检组织学将其分为4期,分别为S0(28例),S1(57例),S2(65例)和S3(52例)期.采用彩色多普勒超声检测仪对患者门静脉血流动力学指标进行分析.结果 肝纤维化S1～S3期患者门静脉、脾静脉以肠系膜上静脉内径(Dpv、Dsv、Dsmv)均明显大于S0期[分别为(1.48±0.19)、(1.52±0.25)、(1.98±0.26) cm比(1.05±0.22) cm,(1.17±0.25)、(1.38 ±0.31)、(1.62±0.34)cm比(0.81±0.24)cm,( 1.28±0.25)、(1.65±0.61)、(1.87±0.57)cm比(0.99 ±0.21 )cm];门静脉和肠系膜上静脉血流速度(Vsmv、Vsv)明显低于S0期[(18±5)、(14±4)、(12±4) cm/s比(25±5)cm/s,(20±6)、(17±7)、(14±7)cm/s比(32±7) cm/s]；门静脉和脾静脉血流量(Qpv、Qsv)明显高于S0期[ (747±1801)、(951±152)、(1010±143)ml/min比(667±167) ml/min,( 648±229)、(758±201)、( 856±214) ml/min比(265±135)ml/min],而肠系膜上静脉血流量(Qsmv)明显低于S0期[(625±132)、(599±112)、(535±150)ml/min比(755±102) ml/min]；以上差异均有统计学意义(P＜0.05或P＜0.01),并随着患者肝纤维化程度的加重变化加剧.结论 彩色多普勒超声对乙型肝炎肝纤维化诊断具有重要的价值.