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目的:观察海勤人员非酒精性脂肪肝(NAFLD)患者门脉系统血流动力学的改变。方法:随机抽取男性海勤人员181例,根据肝脏超声结果分为正常组45例,脂肪肝倾向组48例,轻度NAFLD组50例,中重度NAFLD组38例。超声检测并比较各组门静脉(PV)、脾静脉(SPV)的内径、血流速、血流量,以及肝静脉血流频谱波形。结果:中重度NAFLD组PV内径、SPV内径均显著宽于正常组和脂肪肝倾向组,PV流速、SPV流速均显著低于以上两组(P<0.05);正常组肝静脉正常波形检出率均显著或非常显著高于其他3组(P<0.05,P<0.01);脂肪沉积程度与PV内径、肝静脉异常频谱波形数量呈正相关,与PV流速、SPV流速呈负相关(P<0.05)。结论:海勤人员在肝内脂肪沉积早期,门脉系统血流动力学的改变不显著,仅表现为肝静脉频谱异常波形增多,发展至轻度NAFLD时,PV内径增宽,流速减慢;发展至中重度NAFLD时,PV血流量减少,SPV流速减慢。
Objective: To observe the changes of portal system hemodynamics in patients with nonalcoholic fatty liver disease (NAFLD). Methods: Seventy-one male patients were randomly divided into normal group (45 cases), fatty liver predisposition group (48 cases), mild NAFLD group (50 cases) and moderate-severe NAFLD group (38 cases). The diameter of portal vein (PV) and splenic vein (SPV), blood flow velocity, blood flow and hepatic venous flow waveform were detected by ultrasound. Results: The PV inner diameter and SPV inner diameter of moderate and severe NAFLD group were significantly wider than those of normal group and fatty liver group. PV flow velocity and SPV flow velocity were significantly lower than those of the above two groups (P <0.05) (P <0.05, P <0.01). The degree of fat deposition was positively correlated with the diameter of PV and the number of abnormal hepatic venous waveforms, and negatively correlated with the PV velocity and SPV velocity (P <0.05) . Conclusion: In the early stage of intrahepatic fat deposition, the hemodynamic changes of portal system are not significant, only the abnormal waveform of hepatic venous spectrum is increased. When developing to mild NAFLD, the inner diameter of PV expands and the flow velocity slows down. When developing to moderate-to-severe NAFLD, the PV blood flow decreases and the SPV flow rate slows down.