彩色多普勒超声在预测肝移植术后动脉并发症中的临床价值

Clinical Value of Color Doppler Ultrasound in Predicting Arterial Complications after Liver Transplantation

摘要: 目的：评价彩色多普勒超声(CD-US)血流动力学参数在肝移植术后肝动脉并发症中的预测价值。方法：将11例术后发生动脉并发症受者列为观察组，429例无动脉并发症受者列为对照组，采用两独立样本t检验或Wilcoxon符号秩和检验比较两组术后第1天血流动力学参数，通过受试者工作特征(ROC)曲线评价术后肝动脉直径、肝动脉收缩期峰值流速(PSV)、肝动脉阻力指数(RI)在预测术后动脉并发症的价值。P < 0.05差异有统计学意义。结果：观察组与对照组肝动脉直径(P = 0.002)、PSV (P = 0.04)、RI (P = 0.003)差异具有统计学意义。ROC曲线分析得出：当肝动脉直径 ≤ 0.31 cm、PSV ≤ 58.1 cm/s、RI ≤ 0.58时，预测动脉并发症的灵敏度分别为72.7%、81.8%、72.7%，特异度分别为71.8%，48.9%，85.1%，曲线下面积(AUC)分别为0.752 (95%CI: 0.588~0.917)、0.635 (95%CI: 0.481~0.790)、0.794 (95%CI: 0.643~0.945)。结论：术后彩色多普勒超声对动脉并发症具有良好的预测价值，术后应密切监测肝动脉血流动力学变化。

Abstract: Objective: We purposed to evaluate the value of hemodynamic parameters of color Doppler ultrasound (CD-US) in predicting hepatic artery complications after liver transplantation. Method: 11 patients with postoperative arterial complications were included in the observation group and 429 patients without arterial complications were included in the control group. Two independent samples t test or Wilcoxon signed rank sum test were used to compare the hemodynamic parameters of CD-US on the first day after operation. The value of postoperative arterial diameter, PSV and RI in predicting postoperative arterial complications was evaluated by receiver operating characteristic (ROC) curve. Result: There were statistical differences in hepatic artery diameter (P = 0.002), PSV (P = 0.04), RI (P = 0.003) between the observation group and the control group. Taking a hepatic artery diameter ≤ 0.31 cm, PSV of ≤ 58.1 cm/s and RI ≤ 0.6 as threshold to predict artery complications, the sensitivity and specificity were 72.7%, 81.8%, 72.7%, and 71.8%, 48.9%, 85.1%, respectively. AUC value of hepatic artery diameter, PSV and RI were 0.752 (95%CI: 0.588~0.917), 0.635 (95%CI: 0.481~0.790) and 0.794 (95%CI: 0.643~0.945), respectively. Conclusion: Postoperative CD-US has a good predictive value for arterial complications. The hemodynamic changes of hepatic artery should be routinely monitored after operation by CD-US.