Dietrich C F, Lee J H, Gottschalk R, Herrmann G, Sarrazin C, Caspary W F, Zeuzem S
Medizinische Klinik II, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.
AJR Am J Roentgenol. 1998 Aug;171(2):437-43. doi: 10.2214/ajr.171.2.9694471.
The flow pattern in hepatic veins depends on cardiac physiology and liver histology. The aim of our study was to determine the dependence of the flow pattern of hepatic and portal veins in relation to histologic features in patients with chronic hepatitis C.
In 135 patients with chronic hepatitis C, the Doppler sonography spectrum of the right hepatic vein was classified as triphasic, biphasic, or monophasic. The flow of the portal vein was characterized according to the undulation (velocity(max,min)). A liver biopsy was performed during sonography, and biopsy specimens were semiquantitatively evaluated on a histologic activity index and a score of the hepatic fat content. Multiple logistic regression analysis was used to identify the histologic features that might contribute to the type of flow pattern.
The hepatocyte fat content was the only variable associated with an independent effect on the type of flow pattern (monophasic versus triphasic; odds ratio, 16.26; 95% confidence interval, 6.38-41.45; p < .0001). A pronounced undulation in the portal vein was associated with portal inflammation but not with other parameters of the histologic activity index or the intrahepatic fat deposition.
On sonography, the normal flow pattern in the right hepatic vein is triphasic. The monophasic flow pattern in the right hepatic vein is mainly caused by intrahepatic fat deposition and occasionally by inflammatory or fibrotic changes. Conversely, the flow pattern of the portal vein is mainly influenced by portal inflammation.
肝静脉内的血流模式取决于心脏生理学和肝脏组织学。我们研究的目的是确定慢性丙型肝炎患者肝静脉和门静脉血流模式与组织学特征之间的相关性。
对135例慢性丙型肝炎患者，将右肝静脉的多普勒超声频谱分为三相、双相或单相。根据波动情况（最大、最小流速）对门静脉血流进行特征描述。在超声检查期间进行肝活检，并对活检标本进行组织学活性指数和肝脂肪含量评分的半定量评估。采用多因素logistic回归分析来确定可能影响血流模式类型的组织学特征。
肝细胞脂肪含量是唯一对血流模式类型有独立影响的变量（单相与三相；比值比，16.26；95%可信区间，6.38 - 41.45；p <.0001）。门静脉明显波动与门静脉炎症相关，但与组织学活性指数的其他参数或肝内脂肪沉积无关。
超声检查时，右肝静脉的正常血流模式为三相。右肝静脉的单相血流模式主要由肝内脂肪沉积引起，偶尔也由炎症或纤维化改变引起。相反，门静脉血流模式主要受门静脉炎症影响。
