不同证型肝硬化患者的门静脉血流动力学改变

不同证型肝硬化患者的门静脉血流动力学改变陈晓蓉1,李桂明2,王江蓉1,陈建杰3(1.上海市传染病医院中西医结合科,上海200083; 2.上海市传染病医院影像科,上海200083; 3.上海中医药大学附属曙光医院内科,上海200021)[摘要]目的:探索不同中医证型肝硬化患者门静脉血流动力学、肝纤维化指标及肝功能分级的关系。

方法:应用彩色多谱勒超声显像仪测定147例不同证型肝硬化患者的门静脉内径、脾静脉内径、门静脉血流流速、脾静脉血流流速,并检测不同证型肝硬化患者的总胆红素、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、白蛋白、球蛋白、凝血酶原活动度、透明质酸、Ⅲ型前胶原、层粘蛋白、Ⅳ型胶原等相关指标。

结果:不同证型(湿热内蕴、肝气郁结、脾虚湿盛、肝肾阴虚、脾肾阳虚及血瘀证)肝硬化患者门静脉内径无显著性差异;患者门静脉流速、流量,血瘀证与湿热内蕴证比较P<0.05;脾静脉内径,湿热内蕴证与肝肾阴虚证、血瘀证比较P<0.05,与脾肾阳虚证比较P<0.01;脾静脉流速,血瘀证、脾肾阳虚证与湿热内蕴证、肝气郁结证、肝肾阴虚证比较均有显著性差异,P<0.01;脾静脉流量湿热内蕴证与肝肾阴虚证、脾肾阳虚证、血瘀证比较P<0.01;肝纤维化指标透明质酸与Ⅲ型前胶原,肝肾阴虚证与湿热内蕴证比较P<0.05。

在Child-Pugh分级中,C级脾肾阳虚证发生率最高,A级肝气郁结证发生率最高。

结论:肝肾阴虚证、脾肾阳虚证、血瘀证证型肝硬化患者门静脉血流动力学改变与湿热内蕴证和肝气郁结证间存在明显差异。

[关键词]肝硬化;辨证分型;血流动力学;门静脉[中图分类号]R575.2;R241.6 [文献标识码] A [文章编号]1672-1977(2004)03-0178-04Portal hem odyn amics in pa tients with differ ent synd rom es of cir rhosisCHEN Xiao-Rong1,LI Gui-Ming2,WANG Jiang-Rong1,CHEN Jian-Jie3(1.Department of Integrated Traditional Chinese and Western Medicine,Shanghai M unicipal Infectious Disease Hospital,Shanghai 200083,China; 2.Department of Radiology,Shanghai Municipal Infectious Disease Hospital,Shanghai200083,China; 3.Department of Internal M edicine,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai200021,China) ABSTRACT Objective:To explore the relationship between the portal hemodynamics or the indices of liver fibrosis and the liver function score in patients w ith different traditional Chinese medical syndromes of liver cirrhosis.Methods:One hundred and forty-seven cases of liver cirrhosis with different syndromes were included in the study.Diameters and blood flow velocities of the portal vein and splenic vein were tested by color Doppler sonarography.The indices of liver function(TBIL,ALT,AST,Alb,Glb,PTA)and the indices of hepatic fibrosis(HA,PC-Ⅲ,LN,Ⅵ-C)were tested.Results:The diameters of portal vein in liver cirrhosis patients w ith different syndromes (internal accumulation of damp-heat,stagnation of liver-qi,superabundance of dampness due to spleen-asthenia,asthenia of liver and kidney yin,asthenia of spleen and kidney yang,blood stasis)w ere not significantly different.The blood flow velocities and flow volumes of portal vein in patients with the blood stasis syndrome and the internal accumulation of damp-heat syndrome were significantly different (P<0.05).The diameter of splenic vein in patients with the internal accumulation of damp-heat syndrome was significantly different to that of the asthenia of liver and kidney yin syndrome,or the blood stasis syndrome,or the asthenia of spleen and kidney yang syndrome, respectively(P<0.05or P<0.01).The blood flow velocity of splenic vein in patients with the blood stasis syndrome or the asthenia of spleen and kidney yang syndrome w as significantly different to that of the internal accumulation of damp-heat syndrome,or the stagna-tion of liver-qi syndrome,or the asthenia of liver and kidney yin syndrome,respectively(P<0.01).The blood flow volume of splenic vein in patients w ith the internal accumulation of damp-heat syndrome was significantly different to that of the asthenia of liver and kidney yin syndrome,or the asthenia of spleen and kidney yang syndrome,or the blood stasis syndrome,respectively(P<0.01).The liver cirrhosis indices HA and PC-Шin patients w ith the asthenia of liver and kidney yin syndrome were significantly different to those of the internal accumulation of damp-heat syndrome(P<0.05).In Child-Pugh classification,the incidence of Child-Pugh C w as the highest in the asthenia of spleen and kidney yang syndrome,while the incidence of Child-Pugh A was the highest in the stagnation of liver-qi syn-drome.Conclusion:The changes of portal vein dynamics in liver cirrhosis patients with the asthenia of liver and kidney yin syndrome,or the asthenia of spleen and kidney yang syndrome,or the blood stasis syndrome are significantly different to those of the internal accumula-tion of damp-heat syndrome and the stagnation of liver-qi syndrome.KE Y W ORDS liver cirrhosis;zheng differentiation-classification;hemodynamics;portal veinJ Chin Integr Med,2004,2(3):178-181①肝硬化门静脉高压存在严重的门静脉系统血流动力学紊乱。

为探讨不同中医证型肝硬化患者门静脉血流动力学、肝纤维化指标及肝功能分级的关系,笔者通过彩色多普勒超声显像仪对147例肝硬化患者的门静脉系统血流动力学变化进行了观察,兹报道如下。

1资料与方法1.1病例选择入选病例均符合第10次全国传染病寄生虫病学术会议修订的病毒性肝炎防治方案[1]。

共147例,男129例(87.8%),女18例(12.2%);年龄36～69岁,平均(47.8±12.1)岁;病程最短7年,最长15年,平均(11.3±5.2)年。

其中143例为乙型肝炎肝硬化,4例为丙型肝炎肝硬化。