三维能量多普勒对肝炎孕妇肝脏灌注的评估价值

目的　应用三维彩色能量多普勒超声成像（3D-CPA）评估妊娠13～41孕周乙型肝炎（乙肝）孕妇的肝脏灌注的价值。方法　选取2012年2月－2013年6月孕检的13～41孕周孕妇117例，其中乙肝孕妇73例和健康孕妇44例。在孕妇肝右叶门静脉分支附近进行采样，通过虚拟组织计算机辅助分析软件（VOCAL）分析获得血管化指数（VI）、血流指数（FI）、血管化血流指数（VFI）。比较乙肝孕妇与健康孕妇的肝脏灌注差异。结果　乙型肝炎病毒（HBV）-DNA病毒载量组和对照组之间由3D-CPA获得的肝脏血管指数差异有统计学意义（P＜0.05），3个血管指数的临界值分别为VI=8.760（P＜3×10?4）、FI=22.180（P＜6×10?7）、VFI=1.575（P＜3×10?5）。结论　应用3D-CPA评估肝脏灌注可以分辨感染HBV的孕妇与健康孕妇，在一定程度上为临床预防和治疗孕妇感染HBV提供帮助。

[1]  [ 1 ]　Rubin JM, Bude RO, Carson PL, et al. Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US[J]. Radiology, 1994, 190(3): 853-856.

[2]  [ 2 ]　Pairleitner H, Steiner H, Hasenoehrl G, et al. Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization[J]. Ultrasound Obstet Gynecol, 1999, 14(2): 139-143.

[3]  [ 3 ]　Merce LT, Barco MJ, Bau S, et al. Assessment of placental vascularization by three-dimensional power Doppler “vascular biopsy” in normal pregnancies[J]. Croat Med J, 2005, 46(5): 765-771.

[4]  [ 4 ]　Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures[J]. J Viral Hepat, 2004, 11(2): 97-107.

[5]  [ 5 ]　Ni YH, Chang MH, Huang LM, et al. Hepatitis B virus infection in children and adolescents in a hyperendemic area: 15 years after mass hepatitis B vaccination[J]. Ann Intern Med, 2001, 135(9): 796-800.

[6]  [ 6 ]　Iwamoto K. Estimation of gestational age with ultrasonographic measurement of the fetus in each trimester[J]. Nihon Sanka Fujinka Gakkai Zasshi, 1983, 35(12): 2330-2338.

[7]  [ 7 ]　Kim SU, Lee JH, Kim DY, et al. Prediction of liver-related events using fibroscan in chronic hepatitis B patients showing advanced liver fibrosis[J]. PLoS One, 2012, 7(5): e36676.

[8]  [ 8 ]　Apgar V. A proposal for a new method of evaluation of the newborn infant[J]. Curr Res Anesth Analg, 1953, 32(4): 260-267.

[9]  [ 9 ]　Van Heijst ML, Van Roosmalen G, Keirse MJ. Classifying meconium-stained liquor: is it feasible[J]. Birth, 1995, 22(4): 191-195.

[10]  　Degertekin B, Lok AS. When to start and stop hepatitis B treatment: can one set of criteria apply to all patients regardless of age at infection[J]. Ann Intern Med, 2007, 147(1): 62-64.

[11]  　Nakai A, Sekiya I, Oya A, et al. Assessment of the hepatic arterial and portal venous blood flows during pregnancy with Doppler ultrasonography[J]. Arch Gynecol Obstet, 2002, 266(1): 25-29.

[12]  　Raine-Fenning NJ, Nordin NM, Ramnarine KV, et al. Determining the relationship between three-dimensional power Doppler data and true blood flow characteristics: an in-vitro flow phantom experiment[J]. Ultrasound Obstet Gynecol, 2008, 32(4): 540-550.

[13]  　Han GR, Xu CL, Zhao W, et al. Management of chronic hepatitis B in pregnancy[J]. World J Gastroenterol, 2012, 18(33): 4517-4521.

[14]  　Su ZZ, Shan H, Ke WM, et al. Portalsystemic hemodynamic changes in chronic severe hepatitis B: an ultrasonographic study[J]. World J Gastroenterol, 2008, 14(5): 795-799.

[15]  　Ter Borg MJ, Leemans WF, De Man RA, et al. Exacerbation of chronic hepatitis B infection after delivery[J]. J Viral Hepat, 2008, 15(1): 37-41.