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目的研究分析超声诊断对乙型肝炎肝硬化患者肝静脉压力梯度(hepatic venous pressure gradient,HVPG)的评估价值。方法收集2014年7月—2016年3月间德清县人民医院慢性乙型肝炎肝硬化患者临床资料,共96例乙型肝炎肝硬化患者纳入研究,对所有入组患者进行HVPG测定,根据HVPG水平将入组患者分为高压组(16例)、正常高值组(28例)及正常组(52例)3组。对门静脉、肝右静脉及脾静脉等进行超声检查,收集内径、流速、血流量及充血指数等血管的超声指标,采用方差分析进行组间差异比较,采用Spearman分析HVPG与超声相关指标的相关性,采用Logistic回归分析对HVPG与超声相关指标的相关性进行多因素分析,综合评估超声诊断对乙型肝炎肝硬化患者HVPG的价值。结果不同肝静脉压力梯度水平的患者在肝功能分级、门静脉(PV)内径、PV流速、PV血流量及PV充血指数方面差异具有统计学意义(P<0.05)。Spearman检验显示去除干扰因素后肝功能及门静脉内径和充血指数与HVPG均呈正相关(r=0.524,P<0.001;r=0.614,P<0.001;r=0.458,P<0.001),门静脉流速则与HVPG呈负相关(r=-0.378,P=0.039)。将有统计差异的指标带入Logistic回归分析显示门静脉内径和充血指数与HVPG独立相关(OR=2.397,P=0.020;OR=2.708,P=0.013)。结论超声指标门静脉内径和充血指数与HVPG呈独立正相关,临床可依据二者评估肝静脉压力梯度,为临床诊疗提供依据。
Objective To study the value of ultrasonic diagnosis in evaluating hepatic venous pressure gradient (HVPG) in patients with liver cirrhosis. Methods Clinical data of patients with chronic hepatitis B cirrhosis from Deqing People’s Hospital from July 2014 to March 2016 were collected. A total of 96 patients with hepatitis B cirrhosis were enrolled in the study. HVPG was measured in all patients. According to HVPG level Patients were divided into high-pressure group (16 cases), normal high-value group (28 cases) and normal group (52 cases). The portal vein, the right hepatic vein and the splenic vein were examined by ultrasound, and the indexes such as internal diameter, flow velocity, blood flow and congestive index were collected. The variance analysis was used to compare the differences between groups. Spearman analysis was used to analyze the correlation between HVPG and ultrasound-related indicators Logistic regression analysis was used to analyze the correlation between HVPG and ultrasound-related parameters by multivariate analysis to evaluate the value of ultrasound diagnosis of HVPG in patients with hepatitis B cirrhosis. Results There were significant differences in liver function grading, diameter of PV, PV flow rate, PV blood flow and PV hyperemia index in patients with different hepatic venous pressure gradient (P <0.05). Spearman test showed that hepatic function and portal vein diameter and congestion index were positively correlated with HVPG (r = 0.524, P <0.001; r = 0.614, P <0.001; r = 0.458, P <0.001) HVPG was negatively correlated (r = -0.378, P = 0.039). Logistic regression analysis showed statistically significant differences in portal vein diameter and congestion index were independently associated with HVPG (OR = 2.397, P = 0.020; OR = 2.708, P = 0.013). Conclusion Ultrasound index of portal vein diameter and congestion index and HVPG showed an independent positive correlation between the clinical assessment of both can be based on the hepatic venous pressure gradient, provide the basis for clinical diagnosis and treatment.