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目的通过回顾性探讨门静脉和肝动脉的彩色 Doppler 超声检查参数在诊断肝硬化门静脉高压症的敏感性和特异性,并提出在中国人群中上述参数的正常参考值。方法自2001年7月到2004年3月,选取普外科门诊的可疑肝硬化病人和部分正常人群共110例,共有99例完全符合人选标准和检测标准。99例病人全部经肝穿刺活检或手术中取肝组织活检为金标准分为正常组和硬化组,分别测量正常组和硬化组的门静脉流速(PVV)、肝动脉搏动指数(HA-PI)和肝血管指数(LVI),以及上述指标在诊断肝硬化和门静脉高压症的敏感性和特异性,并根据 ROC 曲线推算出上述指标的正常参考值。结果硬化组的 PW 明显低于正常组的 PVV,(11.0±2.5)cm/s vs(16.9±2.9)cm/s,(P<0.001),硬化组的 HA-PI 明显高于正常组的 HA-PI,(1.2±0.2)vs(0.9±0.2),(P<0.001),硬化组的肝脏 LVI 明显低于正常组的 LVI,(9.1±0.6)vs(19.1±1.9),(P<0.001)。PVV为14 cm/s 时诊断肝硬化门静脉高压症的敏感性为91.7%,特异性为91.7%。HA-PI 为1.1时诊断肝硬化门静脉高压症的敏感性为82.6%,特异性为83.3%。LVI 为10时诊断肝硬化门静脉高压症的敏感性为93.8%,特异性为93.8%。结论肝硬化门静脉高压症时门静脉和肝动脉的血流动力学有明显的改变,这种改变反映到彩色 Doppler 超声检查参数以 LVI 诊断的敏感性和特异性最高。
Objective To investigate the sensitivity and specificity of color Doppler sonography in the diagnosis of portal hypertension in cirrhotic patients by retrospectively analyzing the normal reference values of these parameters in Chinese population. Methods From July 2001 to March 2004, a total of 110 patients with suspected cirrhosis and some normal subjects were enrolled in the GPO. A total of 99 patients completely met the criteria of human selection and testing. All 99 patients were divided into normal group and sclerosis group by biopsy of liver biopsy or liver biopsy in operation. The PVV, HA-PI and Hepatic vascular index (LVI), as well as the sensitivity and specificity of the above indexes in the diagnosis of cirrhosis and portal hypertension, and the normal reference values of the above indexes are deduced according to the ROC curve. Results The PW of the sclerosis group was significantly lower than that of the normal group (11.0 ± 2.5) cm / s vs (16.9 ± 2.9) cm / s, P <0.001. The HA-PI of the sclerosis group was significantly higher than that of the normal group (P <0.001). The LVI in the liver of the sclerotic group was significantly lower than that of the normal group (9.1 ± 0.6 vs 19.1 ± 1.9, P <0.001) ). The sensitivity and specificity of diagnosing cirrhosis and portal hypertension were 91.7% and 91.7%, respectively, at a PVV of 14 cm / s. The sensitivity and specificity of diagnosing cirrhosis and portal hypertension were 82.6% and 83.3%, respectively, when HA-PI was 1.1. The sensitivity and specificity of 93.8% and 93.8%, respectively, for the diagnosis of cirrhotic portal hypertension with an LVI of 10. Conclusion The hemodynamics of portal vein and hepatic artery in cirrhotic patients with portal hypertension have obvious changes. This change reflects that the sensitivity and specificity of color Doppler sonography in diagnosis of LVI are the highest.