肝动脉血流阻力指数对非酒精性脂肪性肝病患者进展期肝纤维化的评估价值

王诚; 陈厚斌; 马龙; 田泽斌; 郑直; 周明雄

doi:10.3969/j.issn.1001-5256.2018.12.014

肝动脉血流阻力指数对非酒精性脂肪性肝病患者进展期肝纤维化的评估价值

DOI: 10.3969/j.issn.1001-5256.2018.12.014

1. 湖北省公安县人民医院肝胆外科
2. 三峡大学附属仁和医院

详细信息

中图分类号: R575
计量
- 文章访问数: 1927
- HTML全文浏览量: 53
- PDF下载量: 333
- 被引次数: 0
出版历程
- 出版日期: 2018-12-20

Value of hepatic artery resistance index in evaluating progressive liver fibrosis in nonalcoholic fatty liver disease

摘要

摘要: 目的明确非酒精性脂肪性肝病（NAFLD）患者血流相关指数的变化,探讨肝动脉血流阻力指数在进展期肝纤维化中的应用价值。方法选取公安县人民医院2016年1月-2017年12月确诊为NAFLD的患者148例及健康志愿者60例为研究对象,采集空腹静脉血测定肝功能、血常规,计算NAFLD患者的NAFLD纤维化评分（NFS）。按NFS结果将NAFLD患者分为A组（NFS≤0. 676）、B组（NFS>0. 676）,以健康人群作为对照组。所有研究对象应用多普勒超声测量肝门静脉峰值（PPVV）、门静脉平均流速（MPVV）及肝动脉血流阻力指数（HARI）。计量资料3组间比较先进行方差分析,若有差异再采用SNK-q法进行多重比较;计数资料组间比较采用χ2检验。采用Spearman秩相关分析不同评价指标间的相关性。结果 148例患者中A组121例,B组27例,HARI值在A组（0. 64±0. 08）、健康对照组（0. 76±0. 09）、B组（0. 88±0. 05）中依次增高,差异有统计学意义（F=4. 981,P <0. 01）,MPVV、PPVV在健康人群[（22. 84±3. 12）...
- 非酒精性脂肪性肝病 /
- 肝硬化 /
- 肝动脉 /
- 血流动力学
Abstract: Objective To investigate the changes in blood flow indices in patients with nonalcoholic fatty liver disease (NAFLD) and the value of hepatic artery resistance index (HARI) in evaluating progressive liver fibrosis. Methods A total of 148 patients who were diagnosed with NAFLD in The People's Hospital of Gong'an County from January 2016 to December 2017 and 60 healthy volunteers were selected as study subjects. Fasting venous blood samples were collected for liver function evaluation and routine blood test, and then NAFLD fibrosis score (NFS) was calculated for NAFLD patients. According to NFS, the patients with NAFLD were divided into group A (NFS ≤0. 676) and group B (NFS > 0. 676) . The healthy volunteers were enrolled as control group. Color Doppler ultrasound was performed to measure peak portal vein velocity (PPVV) , mean portal vein velocity (MPVV) , and HARI in all subjects. An analysis of variance was used for comparison of continuous data between three groups, and the SNK-q test was used for multiple comparisons; the chi-square test was used for comparison of categorical data between groups. A Spearman' s rank correlation analysis was used to investigate the correlation between assessment indices. Results There were 121 patients in group A and 27 in group B. Group B had the highest HARI (0. 88 ± 0. 05) , followed by the control group (0. 76 ± 0. 09) and group A (0. 64 ± 0. 08) , and there was a significant difference between groups (F =4. 981, P < 0. 01) . The control group had the highest MPVV (22. 84 ± 3. 12 cm/s) and PPVV (19. 02 ± 1. 97 cm/s) , followed by group A (17. 84 ± 2. 87 cm/s and 15. 29 ± 2. 02 cm/s) and group B (15. 31 ± 2. 29 cm/s and 13. 39 ± 1. 92 cm/s) , and there were significant differences between groups (F = 5. 645 and 7. 435, both P < 0. 01) . In the patients with NAFLD, HARI was positively correlated with NFS (r = 0. 763, P < 0. 01) , and MPVV and PPVV were negatively correlated with NFS (r =-0. 463 and-0. 425, both P < 0. 01) . Conclusion There are hemodynamic changes of the liver in NAFLD patients with progressive liver fibrosis. HARI can be used as a noninvasive method to evaluate whether NAFLD patients develop progressive liver fibrosis. The development of progressive liver fibrosis should be considered in case of abnormal increase in HARI.
- nonalcoholic fatty liver disease /
- liver cirrhosis /
- hepatic artery /
- hemodynamics

HTML全文

参考文献(14)

[1] NOUREDDIN M, LAM J, PETERSON MR, et al. Utility of magnetic resonance imaging versus histology for quantifying changes in liver fat in nonalcoholic fatty liver disease trials[J]. Hepatology, 2013, 58 (6) :1930-1940.

[2] National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association; Fatty Liver Expert Committee, Chinese Medical Doctor Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease:A 2018 update[J]. J Clin Hepatol, 2018, 34 (5) :947-957. (in Chinese) 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南 (2018年更新版) [J].临床肝胆病杂志, 2018, 34 (5) :947-957.

[3] FAN RB, FANG XL, MENG ZH, et al. Arelative research of renal interstitial fibrosis using ultrasonography and dynamic computer tomography contrast scan[J]. J Pract Med Tech, 2008, 15 (18) :2313-2315. (in Chinese) 范锐斌, 方先来, 孟志华, 等.超声与动态增强CT扫描诊断肾间质纤维化的对比研究[J].实用医技杂志, 2008, 15 (18) :2313-2315.

[4] LI ZX, HE Y, WU J, et al. Study on serum fibrosis markers in hepatic fibrosis and hemodynamics on Doppler ultrasonography in infant hepatitis syndrome[J]. Chin J Ultrasound, 2005, 21 (6) :436-440. (in Chinese) 李智贤, 何云, 吴棘, 等.婴儿肝炎综合征的超声和血清肝纤维化标志物检测研究[J].中国超声医学杂志, 2005, 21 (6) :436-440.

[5] GUO ZQ, WANG QY, QI XS, et al. Recommendations for the diagnosis and management of nonalcohilic fatty liver diseases:Practice guidance from the American Association for the Study of Liver Diseases (2017) [J]. J Clin Hepatol, 2017, 33 (12) :2275-2277. (in Chinese) 郭泽淇, 王倩怡, 祁兴顺, 等.《2017年美国肝病学会非酒精性脂肪性肝病诊疗指导》摘译[J].临床肝胆病杂志, 2017, 33 (12) :2275-2277.

[6] MUSSO G, GAMBINO R, CASSADER M, et al. Meta-analysis:Natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity[J]. Ann Med, 2011, 43 (8) :617-649.

[7] NASR P, IGNATOVA S, KECHAGIAS S, et al. Natural history of nonalcoholic fatty liver disease:A prospective follow-up study with serial biopsies[J]. Hepatol Commun, 2017, 2 (2) :199-210.

[8] LI Y, LU LG. Molecular basis of hepatic fibrosis and current status of its diagnosis and treatment[J]. J Clin Hepatol, 2018, 34 (1) :12-15. (in Chinese) 李妍, 陆伦根.肝纤维化的分子基础与临床诊治现状[J].临床肝胆病杂志, 2018, 34 (1) :12-15.

[9] HAGSTROM H, ELFWEN O, HULTCRANTZ R, et al. Is not associated with an increased risk for fibrosis progression in nonalcoholic fatty liver disease[J]. Gastroenterol Res Pract, 2018, 2018:1942648.

[10] TOPAL NB, ORCAN S, SIGˇIRI D, et al. Effects of fat accumulation in the liver on hemodynamic variables assessed by Doppler ultrasonography[J]. J Clin Ultrasound, 2015, 43 (1) :26-33.

[11] BALASUBRAMANIAN P, BOOPATHY V, GOVINDASAMY E, et al.Assessment of portal venous and hepatic artery haemodynamic variation in non-alcoholic fatty liver disease (NAFLD) patients[J]. J Clin Diagn Res, 2016, 10:7-10.

[12] SUN YH, HUANG GY, ZHENG S, et al. Value of color Doppler ultrasonography in evaluating the vascular hemodynamic change of liver fibrois in infants with biliary atresia[J/CD]. Chin J Med Ultrasound:Electronic Edition, 2012, 9 (1) :29-35. (in Chinese) 孙颖华, 黄国英, 郑珊, 等.彩色多普勒超声检侧不同程度肝纤维化胆道闭锁婴儿肝内血流动力学变化的价值[J/CD].中华医学超声杂志:电子版, 2012, 9 (1) :29-35.

[13] ERGELEN R, YILMAZ Y, ASEDOV R, et al. Comparison of Doppler ultrasound and transient elastography in the diagnosis of significant fibrosis in patients with nonalcoholic steatohepatitis[J]. Abdom Radiol (NY) , 2016, 41 (8) :1505-1510.

[14] CAO JY, JIN Z. Advances in Contrast-enhanced Ultrasound Applied Research[J]. Clin J Med Offic, 2017, 45 (5) :441-448. (in Chinese) 曹军英, 金壮.超声造影应用研究进展[J].临床军医杂志, 2017, 45 (5) :441-448.

施引文献

资源附件(0)

访问统计