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目的探讨彩色多普勒超声评价自体骨髓干细胞移植治疗乙型肝炎肝硬化失代偿期患者疗效的应用价值。方法经肝动脉行自体骨髓干细胞移植治疗的乙型肝炎肝硬化失代偿期患者43例,分别于治疗前1～3d内,治疗后第3个月和6个月观察患者腹水情况,肝脏形态和内部回声变化,以及门静脉系统血流颜色变化,并用超声测量肝脏门静脉内径和门静脉血流速度;脾脏厚径、脾静脉内径和脾静脉血流速度。结果①与术前比较,自体骨髓干细胞移植术后第3个月腹水量减少者35例,肝脏形态和内部回声无明显变化,门静脉和脾静脉血流颜色变明亮,门静脉血流速度增快(P<0.01);脾脏缩小,脾静脉内径变窄,以及脾静脉血流速度增快(P<0.05)。②与术前比较,术后第6个月腹水量减少者41例,且其中15例完全消失,门静脉和脾静脉血流颜色明亮,肝脏形态和内部回声未见明显变化,门静脉内径变细(P<0.05),门静脉血流速度明显增快(P<0.01);脾脏明显缩小,脾静脉内径变窄,脾静脉血流速度明显增快(P<0.01)。术后3个月与6个月比较,其门静脉血流速度,脾脏厚径减小,脾静脉内径变小,脾脏静脉血流速度增快,差异均有统计学意义(均P<0.05)。结论彩色多普勒超声通过观察门静脉系统血流颜色及血流动力学变化,对临床评价自体骨髓干细胞移植治疗乙型肝炎肝硬化失代偿期患者的效果有重要的指导意义。
Objective To evaluate the value of color Doppler ultrasound in the evaluation of autologous bone marrow stem cell transplantation in the treatment of patients with decompensated hepatitis B cirrhosis. Methods Forty-three patients with decompensated hepatitis B cirrhosis were treated with autologous bone marrow stem cell transplantation via hepatic artery. The ascites and the morphology of liver were observed at 1 to 3 days before treatment and at 3 and 6 months after treatment, respectively And internal echo changes, as well as changes in the color of the blood flow in the portal vein system. The diameter of the portal vein and the portal vein blood flow were measured by ultrasonography; the diameter of the spleen, the diameter of the splenic vein and the blood flow velocity of the splenic vein. Results ①Compared with preoperative, in the third month after autologous bone marrow stem cell transplantation, the amount of ascites was reduced in 35 cases. There was no obvious change in the morphology and internal echo of the liver. The blood flow of the portal vein and splenic vein changed brightly and the portal vein blood flow increased rapidly P <0.01). The spleen was reduced, the diameter of splenic vein was narrowed, and the splenic vein blood flow rate was increased (P <0.05). ②Compared with preoperative, in the 6th month after operation, 41 cases of ascites decreased and 15 cases disappeared completely. The color of blood flow in portal vein and splenic vein was bright. There was no obvious change in liver morphology and internal echo. The diameter of portal vein became thinner P <0.05). The velocity of portal vein was significantly increased (P <0.01). The spleen was significantly reduced and the diameter of splenic vein narrowed. The splenic vein blood flow velocity was significantly increased (P <0.01). Compared with 6 months after operation, the portal vein blood flow velocity, the thickness of spleen decreased, the diameter of splenic vein became smaller, and the velocity of splenic venous blood flow increased significantly. There were significant differences between the two groups (all P <0.05). Conclusion Color Doppler echocardiography is an important guide for the clinical evaluation of autologous bone marrow stem cell transplantation in the treatment of patients with decompensated hepatitis B due to the observation of changes in the color and hemodynamics of the portal vein.