Bhutto Abdul Rabb, Abbasi Amanullah, Butt Nazish, Khan Azizullah, Munir Syed Mohammed
Ward-7, Jinnah Postgraduate Medical Centre, Karachi.
J Pak Med Assoc. 2012 Aug;62(8):794-7.
To determine the correlation of hepatic venous waveform changes with severity of hepatic dysfunction and grading of oesophageal varices.
A cross-sectional analytical study was conducted at Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January 2009 to December 2009. Cirrhotic patients with portal hypertension were included in study. Patients presented with acute variceal bleeding, previous treatment with beta blockers or nitrates, sclerotherapy endoscopic band ligation, portal vein thrombosis, severe clotting defects, hepatic encephalopathy grade III or IV and noncirrhotic portal hypertension; were excluded from the study. Upper G I endoscopy was carried out in all patients after informed consent. Oesophageal varices were classified according to Baveno III while hepatic function was assessed and grouped by Child-Pugh classification. Colour Doppler ultrasound was carried out on all patients. Their waveforms were classified as monophasic, biphasic triphasic and the correlation of these hepatic vein waveforms with Child-Pugh class and size of oesophageal varices was evaluated. Statistical significance was defined as P?0.05.
Total of 65 patients who met the inclusion criteria and included in the study with mean age of 47.39 +/- 10.91 (range 23-70) years. Among these 51 (78.5%) were males while 14 (21.5%) were females. On the basis of hepatic function 32 (49.2%) patients presented in Child-Pugh Class A, 23 (35.4%) with Class B and 10 (15.4%) patients had Class C. Hepatic venous waveform was triphasic in 5 (7.7%), biphasic in 18 (27.7%), and monophasic in 42 (64.6%) cases. The relationship of these waveforms had significant relation with hepatic dysfunction (p < 0.012) while insignificant with grading of oesophageal varices (p 0.29). Upper GI endoscopy revealed large grade varices in 37 (56.9%) patients, 17 (26.2%) patients had small grade varices while no varices were found in 11 (16.9%) patients.
Hepatic venous waveform pressure changes have significant relation with severity of hepatic dysfunction but insignificant relation with grading of oesophageal varices. Further studies using a combination of various Doppler parameters are required to create indices with a better predictive value.
确定肝静脉波形变化与肝功能障碍严重程度及食管静脉曲张分级之间的相关性。
2009年1月至2009年12月在卡拉奇真纳研究生医学中心第三医疗单元7号病房进行了一项横断面分析研究。纳入患有门静脉高压的肝硬化患者。出现急性静脉曲张出血、先前接受β受体阻滞剂或硝酸盐治疗、硬化疗法内镜下套扎、门静脉血栓形成、严重凝血缺陷、III或IV级肝性脑病以及非肝硬化门静脉高压的患者被排除在研究之外。在所有患者获得知情同意后进行上消化道内镜检查。食管静脉曲张根据巴韦诺III级进行分类，而肝功能则通过Child-Pugh分类法进行评估和分组。对所有患者进行彩色多普勒超声检查。将其波形分类为单相、双相、三相，并评估这些肝静脉波形与Child-Pugh分级和食管静脉曲张大小的相关性。统计学显著性定义为P?0.05。
共有65例符合纳入标准的患者被纳入研究，平均年龄为47.39±10.91（范围23 - 70）岁。其中51例（78.5%）为男性，14例（21.5%）为女性。根据肝功能，32例（49.2%）患者为Child-Pugh A级，23例（35.4%）为B级，10例（15.4%）患者为C级。肝静脉波形三相的有5例（7.7%），双相的有18例（27.7%），单相的有42例（64.6%）。这些波形与肝功能障碍有显著关系（p < 0.012），而与食管静脉曲张分级无显著关系（p 0.29）。上消化道内镜检查显示，37例（56.9%）患者有大分级静脉曲张，17例（26.2%）患者有小分级静脉曲张，11例（16.9%）患者未发现静脉曲张。
肝静脉波形压力变化与肝功能障碍严重程度有显著关系，但与食管静脉曲张分级无显著关系。需要进一步结合各种多普勒参数进行研究以创建具有更好预测价值的指标。
