Kim Moon Young, Baik Soon Koo, Park Dong Hun, Lim Dae Wook, Kim Jae Woo, Kim Hyun Soo, Kwon Sang Ok, Kim Young Ju, Chang Sei Jin, Lee Samuel S
Department of Internal Medicine and Institute of Lifelong Health, Wonju College of Medicine, Yonsei University, Wonju, South Korea.
Liver Int. 2007 Oct;27(8):1103-10. doi: 10.1111/j.1478-3231.2007.01526.x.
Alterations in the Doppler hepatic vein (HV) waveform are associated with cirrhosis and portal hypertension. We prospectively evaluated the correlation between the extent of abnormal Doppler HV waveforms expressed as damping index (DI) and the hepatic venous pressure gradient (HVPG) and response to propranolol in patients with cirrhosis.
In 76 patients with cirrhosis (69 men and seven women), both DI of Doppler HV waveform and HVPG were measured, and the relationship between them was analysed. DI was calculated by the minimum velocity/maximum velocity of the HV waveform. An HVPG>12 mmHg was defined as severe portal hypertension. In a subgroup of 19 patients receiving propranolol, changes in both DI and HVPG were evaluated after propranolol administration for 3 months. One author (S. K. B.) performed all DI of Doppler HV waveform studies.
Abnormal HV waveforms were seen in 66 of 76 patients (86.8%). DI significantly correlated with the grade of HVPG, i.e. with higher HVPG increased DI was observed (P<0.01). By logistic regression analysis, DI>0.6 was significantly more likely to be severe portal hypertension (odds ratio: 14.19, 95% confidence interval: 4.07-49.55). Receiver-operating characteristic curve according to the value of 0.6 of DI showed a sensitivity of 75.9% and a specificity of 81.8% for the presence of severe portal hypertension. In 19 patients of the propranolol subgroup, change of DI following propranolol treatment also significantly correlated with that of HVPG (P<0.01).
Damping index of the HV waveform by Doppler ultrasonography might be a non-invasive supplementary tool in evaluating the severity of portal hypertension and in responding to propranolol in patients with liver cirrhosis.
多普勒肝静脉（HV）波形改变与肝硬化及门静脉高压相关。我们前瞻性评估了以阻尼指数（DI）表示的异常多普勒HV波形程度与肝硬化患者肝静脉压力梯度（HVPG）及对普萘洛尔反应之间的相关性。
对76例肝硬化患者（69例男性和7例女性）测量了多普勒HV波形的DI及HVPG，并分析二者之间的关系。DI通过HV波形的最小速度/最大速度计算得出。HVPG>12 mmHg被定义为重度门静脉高压。在接受普萘洛尔治疗的19例患者亚组中，评估了普萘洛尔给药3个月后DI和HVPG的变化。所有多普勒HV波形研究的DI均由一位作者（S.K.B.）进行测量。
76例患者中有66例（86.8%）出现异常HV波形。DI与HVPG分级显著相关，即HVPG越高，DI越高（P<0.01）。通过逻辑回归分析，DI>0.6时更有可能为重度门静脉高压（比值比：14.19，95%置信区间：4.07 - 49.55）。根据DI值0.6绘制的受试者工作特征曲线显示，对于重度门静脉高压的存在，敏感性为75.9%，特异性为81.8%。在普萘洛尔亚组的19例患者中，普萘洛尔治疗后DI的变化也与HVPG的变化显著相关（P<0.01）。
多普勒超声检查的HV波形阻尼指数可能是评估肝硬化患者门静脉高压严重程度及对普萘洛尔反应的一种无创辅助工具。
