A Relevant Study On The Change Of Entering Liver Hemodynamicsby Color Dopplerultrasonography In Patients With Cirrhosis

Objective To investigate the correlation between the changes of liver inflow tract hemodynamics and the Child-Pugh grade in patients with cirrhosis. Methods The hemodynamic parameters of hepatic artery and portal vein in 80 patients with liver cirrhosis caused by hepatitis B virus and 50 patients with alcoholic cirrhosis were examined by color Doppler flow imaging technique. 50 patients without any abnormality was as controls. All the patients were detected matutinus and on an empty stomach post 8 hours. The body position was prostration or lateral position. First, we used 2D (2-Dimensional) ultrasound condition to detect the liver. The parameters were size, morphous, internal echo, pone echo, characteristics and distribution of the blood vessel. Secondly, we selected the central region of main portal vein and arteria hepatica propria as the detection point, and used colour Doppler condition to detect the liver after we got stable section area of blood vessel. The hemodynamic parameters were blood direction, blood character, blood frequency spectrum. The included angle of frequency spectrum and blood vessel was within 60°. To ensure the accurace of the data, first, we measured the data thrice mannuly and counted the mean value; secondly, we measured the data thrice automaticly and counted the mean value. Finally, we averaged the two mean values above and counted the final mean value. All the data were measured by the same doctor. The hemodynamic parameters of hepatic artery and portal vein were as follow: hepatic artery:inside diameter (DHA), peak systolic velocity (PSV), time average mean glow velocity(TAMVHA), resistent index (RI), pulsatility index (PI), volume of blood flow (Q_HA); portal vein: inside diameter (DPV), peak veloity (Vmax), time average mean glow velocity(TAMVPV), volume of blood flow (Q_PV), perfusion index of hepatic arterial flow (DPI). The volume of blood flow was calculated according to the formula (Q﹦π·D2/4·Vmeax·60 ). The DPI was calculated according to the formula (DPI=Q_HA /(Q_HA + Q_PV)). The hemodynamic parameters of hepatic artery and portal vein were compared with control group, and analysised according to Child-Pugh grade. Results The hemodynamic parameters of hepatic artery and portal vein in VLC group and ALC group were as follow: The peak systolic velocity (PSVHA) (74.1±30.5cm/s;41.5±7.2cm/s); The resistent index (RI) (0.72±0.06; 0.73±0.05); The pulsatility index (PI) (1.6±0.44; 1.7±0.29); The blood flow (Q_HA) (629.5±206.1; 263.4±89.9); The Vmax of the portal vein (13.2±3.4 cm/s; 12.1±4.2 cm/s); The Qpv (945.5±346.9; 670±190.5). The Dpv, DHA were widen in VLC group and ALC group, the flow rate of Vpv was decreased, and Qpv was decreased too, RI and PI were higher than those in control group, there was significant difference between VLC group, ALC group and control group(P<0.05). The haemodynamic changes have significant difference with different etiological factor in VLC group and ALC group. Qpv was decreased and Q_HA was compensated increased in VLC group, while Q_HA was globally decreased in ALC group, RI and PI in ALC group were obviously higher than those in VLC group. VHA, Q_HA were gradually increased and the Vpv, Qpv were gradually decreased with the increasing of Child-Pugh grade in patients with LC. There was good correlation betwee the DPI and the Child-Pugh grade , and the r value was 0.71 in VLC group and 0.69 in ALC group(P=0.000). As the statistical results shown, there is good correlation between the DPI and the Child-Pugh grade in patients with liver cirrhosis. Meanwhile, The 95% confidence interval (CI95%) was calculated according to the formula (mean±1.96 S.D.) in control group, VLC group and ALC group were 0.25±0.15, 0.33±0.29, and 0.19±0.13 respectively. There were significant differences between VLC group, ALC group and control group(P<0.05)in DPI values. Conclusion There is good correlation between the changes of liver inflow tract hemodynamics and the Child-Pugh grade in patients with cirrhosis. The changes of hepatic arterial flow, especially the specificity changes of hepatic artery blood flow could be a judgment factor in the diagnosis of LC caused by different etiological factor, and it has important value in preventing and treating LC.