Perisić Mirjana D, Culafić Dj M, Kerkez M
Institute of Digestive Diseases, Clinical Center of Serbia, Belgrade, Serbia and Montenegro.
Rom J Intern Med. 2005;43(1-2):141-51.
The association between portal hypertension, splenomegaly and splenic hemodynamics has not been clearly defined until these days. Therefore, hemodynamics of splenic blood vessels and the role of spleen in portal hypertension were the aim of our study.
Study included 44 patients with liver cirrhosis and splenomegaly and 25 healthy controls. Using color Doppler duplex ultrasonography, morphological and hemodynamic parameters of portal hypertension were analysed: liver and spleen diameters, presence of ascites, morphology of portal and splenic vein; portal and splenic vein flow velocity, hepatic and splenic artery velocity, arterial resistive and pulsatile Doppler indices.
In patients with liver cirrhosis, significant differences of venous flow in the liver and spleen were found, compared to the control group (p<0.05). Also, splenic vein flow was significantly faster than in the portal vein. On the contrary, in healthy controls, splenic vein flow was significantly slower than in the portal vein. Mean systolic splenic artery velocity in liver cirrhosis was considerably slower (51.07+/-11.91 cm/sec) than in the control group (58.50+/-13.31 cm/sec), while mean diastolic velocity in splenic artery (18.3+/-7.9 cm/sec) was approximate to the flow in the controls (19.76+/-5.58 cm/sec) (p>0.05). In patients with liver cirrhosis, mean systolic (51.07+/-11.91 cm/sec) and mean diastolic velocities (18.3+/-7.9 cm/sec) in the splenic artery were significantly faster than the mean systolic (42.58+/-14.54 cm/sec) and mean diastolic (12.07+/-5.59 cm/sec) velocities in hepatic artery (p<0.05). In patients with liver cirrhosis, mean resistive index (RI) of splenic artery was significantly lower (0.64+/-0.11) compared to mean RI of hepatic artery (0.72+/-0.08) (p<0.001). In healthy controls, mean RI of splenic artery was also significantly lower than mean RI of hepatic artery (p<0.001). In patients with liver cirrhosis, mean pulsatile index (PI) of splenic artery was significantly lower (1.24+/-0.47) than mean PI of hepatic artery (1.56+/-0.46) (p<0.01). In healthy controls, mean PI of spenic artery was significantly lower (1.17+/-0.36) than mean PI of hepatic artery (1.64+/-0.48) (p<0.001), as the result of high diastolic velocity in splenic artery.
We consider that high diastolic velocity in splenic artery is a specific phenomenon and may be a kind of modulated response to hypokinetic venous flow in portal hypertension.
直到如今，门静脉高压、脾肿大与脾血流动力学之间的关联仍未明确界定。因此，本研究旨在探讨脾血管的血流动力学以及脾脏在门静脉高压中的作用。
研究纳入了44例肝硬化伴脾肿大患者和25例健康对照者。采用彩色多普勒双功能超声，分析门静脉高压的形态学和血流动力学参数：肝脏和脾脏直径、腹水情况、门静脉和脾静脉形态；门静脉和脾静脉流速、肝动脉和脾动脉流速、动脉阻力和搏动性多普勒指数。
与对照组相比，肝硬化患者肝脏和脾脏的静脉血流存在显著差异（p<0.05）。此外，脾静脉血流明显快于门静脉。相反，在健康对照者中，脾静脉血流明显慢于门静脉。肝硬化患者脾动脉平均收缩期流速（51.07±11.91 cm/秒）明显慢于对照组（58.50±13.31 cm/秒），而脾动脉平均舒张期流速（18.3±7.9 cm/秒）与对照组血流相近（19.76±5.58 cm/秒）（p>0.05）。肝硬化患者脾动脉平均收缩期（51.07±11.91 cm/秒）和平均舒张期流速（18.3±7.9 cm/秒）明显快于肝动脉平均收缩期（42.58±14.54 cm/秒）和平均舒张期（12.07±5.59 cm/秒）流速（p<0.05）。肝硬化患者脾动脉平均阻力指数（RI）（0.64±0.11）明显低于肝动脉平均RI（0.72±0.08）（p<0.001）。在健康对照者中，脾动脉平均RI也明显低于肝动脉平均RI（p<0.001）。肝硬化患者脾动脉平均搏动指数（PI）（1.24±0.47）明显低于肝动脉平均PI（1.56±0.46）（p<0.01）。在健康对照者中，由于脾动脉舒张期流速较高，脾动脉平均PI（1.17±0.36）明显低于肝动脉平均PI（1.64±0.48）（p<0.001）。
我们认为脾动脉舒张期流速增高是一种特殊现象，可能是对门静脉高压时低动力静脉血流的一种调节反应。
