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Abstract：
To investigate the clinical value of contrast-enhanced ultrasound in the prediction of hepatic encephalopathy (HE) in patients with hepatitis B cirrhosis after intrahepatic portal-systemic shunt via jugular vein. In this retrospective study, we collected data from 75 patients with hepatitis B, cirrhosis, and portal hypertension who underwent jugular intrahepatic portosystemic shunt from February 2019 to February 2022. The diagnostic instrument used was the TOSHIBA Aplio500 color Doppler ultrasound with contrast-enhanced ultrasound capabilities. The trial group comprised 20 patients with HE within 3 months postsurgery, while the control group (CG) included 55 patients without HE within the same postoperative period. All patients underwent various examinations before and within 48 hours after surgery, including observation of liver and spleen size and stent position, as well as assessment of blood flow direction in portal and hepatic veins. Subsequently, contrast-enhanced ultrasound was employed to examine and observe perfusion changes of contrast agents in hepatic veins, hepatic arteries, and portal veins (PV). Changes in PV pressure gradient, intrahepatic, and stent blood flow perfusion (BFP) were explored in both postoperative trials and CGs. The trial group exhibited higher BFP volume, PV pressure gradient difference, and percentage decrease compared to the CG. A weak positive correlation was observed between blood flow within the liver stent and PV pressure gradient difference, as well as the percentage decrease in PV pressure gradient. The correlation coefficient between blood flowing perfusion volume within the stent and the difference in PV pressure gradient was R = 0.415 (P = .000). The correlating coefficient between BFP amount within the stent and the percentage decrease in PV pressure gradient was R = 0.261 (P = .027). The area under the receiver operating characteristic curve for stent perfusion volume, difference in PV pressure gradient, and percentage decrease in PV pressure gradient was 0.691, 0.759, and 0.742, respectively. An increase in PV pressure gradient accelerates blood flow within the stent, predisposing to HE. Changes in hepatic BFP following transjugular intrahepatic portosystemic shunt can effectively predict the occurrence of HE, demonstrating significant clinical relevance.
摘要：
探讨超声造影对乙型肝炎肝硬化患者颈静脉肝内门体分流术后肝性脑病(HE)的预测价值。在这项回顾性研究中,我们收集了75例乙型肝炎患者的数据，肝硬化,以及在2019年2月至2022年2月期间接受颈静脉肝内门体分流术的门脉高压.使用的诊断仪器是具有对比增强超声功能的TOSHIBAAplio500彩色多普勒超声。试验组包括20例术后3个月内的HE患者，对照组（CG）包括55例术后同期无HE的患者。所有患者在手术前和手术后48小时内均接受了各种检查，包括观察肝脏和脾脏的大小和支架的位置，以及评估门静脉和肝静脉的血流方向。随后，采用超声造影观察肝静脉造影剂灌注变化,肝动脉,和门静脉（PV）。PV压力梯度的变化，肝内,在术后试验和CG中对支架血流灌注（BFP）进行了探索。试验组表现出更高的BFP体积，PV压力梯度差,与CG相比，百分比下降。肝脏支架内的血流与PV压力梯度差之间观察到弱正相关。以及PV压力梯度下降的百分比。支架内血流灌注量与肺静脉压力梯度差值的相关系数为R=0.415(P=.000)。支架内BFP量与PV压力梯度下降百分比之间的相关系数为R=0.261（P=0.027）。支架灌注量接收器工作特性曲线下的面积,PV压力梯度的差异，PV压力梯度下降的百分比分别为0.691、0.759和0.742。PV压力梯度的增加加速了支架内的血流，对他易感。经颈静脉肝内门体分流术后肝BFP的变化可有效预测HE的发生,证明了显著的临床相关性。
