Sangma M A, Biswas N, Paul P
Dr Mousumi Anuradha Sangma, Junior Consultant (Radiology & Imaging), Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail: sumisangma @hotmail.com.
Mymensingh Med J. 2019 Oct;28(4):727-733.
Cirrhotic patients have hepatic vein waveform abnormalities (HVWA). Both Doppler ultrasonography of hepatic venous wave form (HVWF) and portal Doppler flowmetry (PDF) can non invasively recognize hepatic vein wave form abnormalities and determine severity of esophageal varices. Here we applied cross sectional study and found out the relation between HVWF and PDF and duration of the study from July 2016 to June 2017 in a tertiary Medical College Hospital, Bangladesh. 49 purposively taken diagnosed, hospital admitted, cirrhotic patients were included. Face to face interview and reviewing of records were the source of data and it was analyzed by SPSS windows version-12 software programs. At first, local ethical committee approved the study protocol, p<0.05 was statistically significant and 95% was confidence interval. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. Alternative diagnostic investigations would be either HVWF or PDF. HVWF were normal triphasic. Abnormal biphasic and monophasic PDF consisted of the maximum values of portal flow velocity, portal vein flow volume, diameter of the portal vein, and congestion index. Small and large varices were the easiest form of endoscopic grading of esophageal varices. No clinical or echocardiographic feature of right sided heart failure had found in any patient. Both HVWF and PDF can certainly demonstrate the presence of varices but only HVWF detected severity of esophageal varices - monophasic wave (60.47%) in Doppler USG which signified (<0.05) large varices (67.44%) in endoscopy and in biphasic wave (31.53%) in Doppler USG which signified small varices (32.66%) in endoscopy. Patients who developed varices had portal vein diameter (PVD) and congestion index (CI) were higher (p<0.02) and portal vein velocity (PVV) was lower (p<0.05) than whom did not develop varices, but severity of varices could not be detected. Portal vein flow volume (PVFV) did not signify the presence or severity of varices. Moderately positive correlation (correlation co-efficient was 0.0064) was found between Doppler USG of HVWF and esophagogastroduodenoscopic in severity detection varices. In determination of severity of esophageal varices in patients with liver cirrhosis Hepatic venous Doppler sonography plays more vital role than PDF.
肝硬化患者存在肝静脉波形异常（HVWA）。肝静脉波形（HVWF）的多普勒超声检查和门静脉多普勒血流测定（PDF）都可以无创地识别肝静脉波形异常，并确定食管静脉曲张的严重程度。在此，我们进行了一项横断面研究，以找出HVWF与PDF之间的关系，该研究于2016年7月至2017年6月在孟加拉国的一家三级医学院附属医院开展。纳入了49例经诊断、入院治疗的肝硬化患者，这些患者是经过有目的地选取的。面对面访谈和病历审查是数据来源，并通过SPSS windows版本12软件程序进行分析。首先，当地伦理委员会批准了研究方案，p<0.05具有统计学意义，95%为置信区间。食管胃十二指肠镜检查是诊断食管静脉曲张的金标准。替代诊断方法可以是HVWF或PDF。HVWF正常为三相波。异常的双相波和单相波PDF包括门静脉流速最大值、门静脉血流量、门静脉直径和充血指数。小静脉曲张和大静脉曲张是食管静脉曲张内镜分级中最容易区分的类型。在任何患者中均未发现右侧心力衰竭的临床或超声心动图特征。HVWF和PDF都能确定静脉曲张的存在，但只有HVWF能检测出食管静脉曲张的严重程度——多普勒超声检查中的单相波（60.47%）表示内镜检查中的大静脉曲张（67.44%），双相波（31.53%）表示内镜检查中的小静脉曲张（32.66%）。出现静脉曲张的患者门静脉直径（PVD）和充血指数（CI）较高（p<0.02），门静脉流速（PVV）较低（p<0.05），而未出现静脉曲张的患者则相反，但无法检测出静脉曲张的严重程度。门静脉血流量（PVFV）不能表明静脉曲张的存在或严重程度。在静脉曲张严重程度检测方面，HVWF的多普勒超声检查与食管胃十二指肠镜检查之间存在中度正相关（相关系数为0.0064）。在确定肝硬化患者食管静脉曲张的严重程度时，肝静脉多普勒超声检查比PDF发挥着更重要的作用。
