Han Steven-Huy B, Rice Susan, Cohen Stanley M, Reynolds Telfer B, Fong Tse-Ling
Division of Gastrointestinal and Liver Diseases, School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Clin Gastroenterol. 2002 May-Jun;34(5):573-7. doi: 10.1097/00004836-200205000-00019.
Acute alcoholic hepatitis (AAH) is a clinical diagnosis associated with increased hepatic artery diameter and flow. Duplex Doppler ultrasound (DDU) has been shown to accurately measure arterial flow in both liver and kidney transplant patients. The authors conducted a blinded, controlled study to evaluate the accuracy of measuring hepatic artery parameters with DDU in diagnosing AAH.
Duplex Doppler ultrasound was performed by an investigator, blinded to group makeup, on 22 consecutive hospital inpatients with the clinical diagnosis of AAH. The diagnosis of AAH was based on specific criteria, including the following: recent alcohol abuse, hyperbilirubinemia, prolonged prothrombin time, leukocytosis, hepatomegaly, hepatic bruit, and marked redistribution of isotope on 99mTc-sulfur colloid liver-spleen scan. Controls were 12 cirrhotic patients without AAH and 17 healthy volunteers. Duplex Doppler ultrasound measurements were obtained most consistently from the proximal right hepatic artery. Measured parameters included the following: peak systolic velocity (PSV); resistive index = (PSV - end diastolic velocity [EDV])/PSV; pulsatility index = (PSV - EDV)/mean velocity; and hepatic artery diameter.
The mean hepatic artery diameter was significantly larger in patients with AAH (3.55 +/- 0.72 mm) than in patients with cirrhosis (2.75 +/- 0.69 mm; p = 0.003) and healthy controls (2.68 +/- 0.69 mm; p = 0.001). The mean PSV was significantly higher in patients with AAH (187 +/- 52 cm/s) compared with cirrhotic (67 +/- 51 cm/s) and healthy (66 +/- 51 cm/s) controls (p = 0.0001). The mean resistive index was lower in AAH patients (0.60 +/- 0.11) compared with cirrhotic (0.69 +/- 0.10; p value was not significant) and healthy controls (0.72 +/- 0.11; p = 0.004). The mean pulsatility index was lower in AAH patients (1.04 +/- 0.47) compared with cirrhotic (1.36 +/- 0.45; p value was not significant) and healthy controls (1.53 +/- 0.45; p = 0.01).
In the appropriate clinical setting, an elevated hepatic artery diameter or PSV measurement is suggestive of AAH. Duplex Doppler ultrasound offers a noninvasive test to assist in the diagnosis of AAH.
急性酒精性肝炎（AAH）是一种与肝动脉直径和血流量增加相关的临床诊断。双功多普勒超声（DDU）已被证明能准确测量肝移植和肾移植患者的动脉血流。作者进行了一项双盲对照研究，以评估用DDU测量肝动脉参数在诊断AAH中的准确性。
由一名对分组情况不知情的研究者，对22例临床诊断为AAH的连续住院患者进行双功多普勒超声检查。AAH的诊断基于特定标准，包括以下内容：近期酗酒、高胆红素血症、凝血酶原时间延长、白细胞增多、肝肿大、肝区杂音以及99mTc-硫胶体肝脾扫描时同位素的明显重新分布。对照组为12例无AAH的肝硬化患者和17名健康志愿者。双功多普勒超声测量最一致地取自肝右动脉近端。测量参数包括：收缩期峰值流速（PSV）；阻力指数=（PSV - 舒张末期流速[EDV]）/PSV；搏动指数=（PSV - EDV）/平均流速；以及肝动脉直径。
AAH患者的平均肝动脉直径（3.55±0.72mm）显著大于肝硬化患者（2.75±0.69mm；p = 0.003）和健康对照组（2.68±0.69mm；p = 0.001）。与肝硬化患者（67±51cm/s）和健康对照组（66±51cm/s）相比，AAH患者的平均PSV显著更高（187±52cm/s）（p = 0.0001）。与肝硬化患者（0.69±0.10；p值无统计学意义）和健康对照组（0.72±0.11；p = 0.004）相比，AAH患者的平均阻力指数更低（0.60±0.11）。与肝硬化患者（1.36±0.45；p值无统计学意义）和健康对照组（1.53±0.45；p = 0.01）相比，AAH患者的平均搏动指数更低（1.04±0.47）。
在适当的临床环境中，肝动脉直径或PSV测量值升高提示AAH。双功多普勒超声提供了一种无创检查方法，有助于AAH的诊断。
