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目的： 探讨慢性病毒性肝炎脾脏声像及血流动力学改变及其与肝纤维化病理分期的关系。方法： 采用临床与病理对照的方法， 用彩色双功多普勒超声检测了 １１２ 例慢性病毒性肝炎伴不同程度肝纤维化患者的脾脏厚度及长径、脾动静脉直径、脾动静脉血流量、脾静脉最大流速、脾动脉收缩期峰值速度及脾动脉阻力指数。结果： 除脾动脉阻力指数外慢性肝炎患者上述所有指标均高于正常人 （Ｐ＜ ０．０１）； 脾脏增大的患者脾动静脉血流参数除脾动脉阻力指数外均高于脾脏不大者 （Ｐ＜ ０．０１）； 脾脏厚度、长径及脾静脉直径在不同肝纤维化程度之间 （Ｓ０～Ｓ４ 期） 比较差异均有统计学意义， 并与肝组织纤维化程度有显著相关 （Ｐ＜ ０．０１）， 其余指标在Ｓ０～４ 组比较差异均无显著性，且与Ｓ 无显著性相关。结论： ①在慢性肝炎及早期肝硬化阶段即可出现脾循环亢进， 这一变化与脾脏动脉性充血有关； ②脾脏厚度及长径、脾静脉管径较脾动静脉血流参数能更好地反映病毒性肝炎纤维化病变程度。
Objective: To investigate the changes of spleen image and hemodynamics in chronic viral hepatitis and its relationship with the pathological stage of liver fibrosis. Methods: The colorimetric Doppler echocardiography was used to detect the thickness and length of spleen, diameter of splenic artery and vein, splenic arteriovenous and venous blood flow in 112 patients with chronic viral hepatitis complicated with hepatic fibrosis by clinical and pathological comparison. Splenic vein maximum flow velocity, splenic artery peak systolic velocity and splenic artery resistance index. Results: All of the above indexes were higher than those of normal persons (P <0.01) except for spleen artery resistance index; splenic arteriovenous blood flow parameters in patients with splenomegaly were higher than splenic artery resistance index except spleen artery resistance index (P <0.01). There was significant difference of spleen thickness, long diameter and splenic vein diameter between different degrees of liver fibrosis (S0 ~ S4), which were significantly correlated with the degree of liver fibrosis (P <0.01). There was no significant difference between the other indexes in S0 ~ 4 group and no significant correlation with S. Conclusions: ①Hypertrophic spleen circulation can occur in chronic hepatitis and early stage cirrhosis, which is related to splenic arterial hyperemia; ② Spleen thickness and long diameter, diameter of splenic vein can be better than splenic arterial and venous blood flow parameters Reflects the degree of viral hepatitis fibrosis.