摘要
目的探讨彩色多普勒超声结合相关生化指标在移植胰静脉血栓早期诊断中的临床意义和超声诊断的重要性。方法回顾性分析广州医科大学附属第二医院2019年6月至2022年9月行胰肾联合移植术181例受者的临床资料。根据是否存在移植胰血栓临床高风险因素(血、尿淀粉酶水平骤降及空腹血糖和D-二聚体水平升高等)将受者分为高风险组(48例)和非高风险组(133例)。应用彩色多普勒超声检查评估移植胰腺及重建血管情况,诊断移植胰血栓。根据供脾静脉是否存在血栓分为有供脾静脉血栓组(6例)和无供脾静脉血栓组(39例)。对比分析各组实验室指标(空腹血糖、血淀粉酶、尿淀粉酶、脂肪酸和D-二聚体水平)和移植胰超声测量值(胰头厚径、胰体厚径、胰尾厚径、供脾静脉内径及血流速度、移植胰实质动脉血流速度及阻力指数)。其中,符合正态分布及方差齐性检验的计量资料组间比较采用t检验,不符合正态分布及方差齐性检验的计量资料组间比较采用Mann-Whitney U检验。结果181例受者中,高风险组空腹血糖、血淀粉酶、尿淀粉酶和D-二聚体水平分别为(14.7±1.9)U/L、(92.6±15.4)mmol/L、(9.7±1.7)U/L和(6.1±2.2)mg/L,非高风险组分别为(4.9±0.6)U/L、(209.4±34.4)mmol/L、(168.2±95.7)U/L和(1.3±0.6)mg/L,组间比较,差异均有统计学意义(P=0.021、0.035、0.001、0.017)。彩色多普勒超声检查诊断移植胰血栓形成9例,均为高风险组受者,移植术后2周内发生8例;移植胰静脉血栓6例,移植术后2周内发生5例,且均发生在供脾静脉。有供脾静脉血栓组和无供脾静脉血栓组的空腹血糖、血淀粉酶、尿淀粉酶和D-二聚体比较,差异均无统计学意义(P值均>0.05)。超声检查结果显示,有供脾静脉血栓组和无供脾静脉血栓组供脾静脉内径分别为(11.7±0.5)mm和(3.9±0.2)mm,供脾静脉血流速度分别为(18.3±8.4)cm/s和(40.3±16.6)cm/s,组间比较,差异均有统计学意义(P=0.001和0.006),但组间移植胰头厚径、胰体厚径、胰尾厚径、移植胰实质动脉血流速度及阻力指数比较,差异均无统计学意义(P值均>0.05)。结论在诊断移植胰血栓形成中,空腹血糖、血淀粉酶、尿淀粉酶、脂肪酸和D-二聚体是重要的生化指标,但不具有特异性。彩色多普勒超声检查可为胰肾联合移植术后发现移植胰静脉血栓形成的早期诊断和干预提供有价值的影像学诊断依据。建议移植术后1~2周内加强彩色多普勒超声的动态监测,尤其要关注供脾静脉内径及其血流速度。
Objective To explore the diagnostic value of color Doppler ultrasonography for transplanted pancreatic venous thrombosis after simultaneous pancreas-kidney transplantation(SPK).Methods From June 2019 to September 2022,retrospective analysis was conducted for the relevant clinical data of 181 recipients of SPK.Based upon a presence or absence of clinical high-risk factors,such as a sudden decline of blood/urine amylase,elevated fasting blood glucose and D-dimer,they were assigned into two groups of high-risk(n=48)and non-high-risk(n=133).Color Doppler ultrasonography was performed for evaluating the status of transplanted pancreas and reconstructed blood vessels and diagnosing pancreatic thrombosis post-SPK.Also they were divided into two groups of donor splenic vein thrombosis(n=6)and non-thrombosis(n=39)based upon the presence or absence of splenic vein thrombosis.Various laboratory parameters(fasting blood glucose,blood/urine amylase,fatty acids&D-dimer)and transplanted pancreatic ultrasonic measurements(thickness of transplanted pancreatic head/body/tail,inner diameter&blood flow velocity of donor splenic vein,transplanted pancreatic parenchymal arterial blood flow velocity and resistance index)were recorded.Measurement data were tested for normal distribution and homogeneity of variances.Group comparisons for measurement data fulfilling the criteria of normal distribution and homogeneity of variances were conducted by t-test.For data not fulfilling these criteria,Mann-Whitney U test was utilized.Results Among 9 cases of pancreatic thrombosis as diagnosed by color Doppler ultrasonography,pancreatic venous thrombosis(n=6)occurred in donor splenic vein.The proportion of transplanted pancreatic thrombosis occurring within Week 2 was 88.9%(8/9)and the proportion of transplanted pancreatic venous thrombosis occurring within Week 23.3%(5/6).Fasting blood glucose,blood amylase,urine amylase and D-dimer of high-risk group were(14.7±1.9)U/L,(92.6±15.4)mmol/L,(9.7±1.7)U/L and(6.1±2.2)mg/L.The corresponding values for non-high-risk group were(4.9±0.6)U/L,(209.4±34.4)mmol/L,(168.2±95.7)U/L and(1.3±0.6)mg/L respectively.Statistically significant inter-group differences existed(P=0.021,0.035,0.001,0.017).Pancreatic thrombosis was diagnosed by color Doppler ultrasonography in 9 patients in high-risk group and 8 cases occurred within Week 2 post-SPK.Among 6 cases of pancreatic venous thrombosis,5 cases occurred in donor splenic veins within Week 2 post-SPK.No significant differences existed in the above parameters between group with donor splenic vein thrombosis and group without donor splenic vein thrombosis(P>0.05).Inner diameters of splenic veins in groups with and without splenic vein thrombosis were(11.7±0.5)and(3.9±0.2)mm.Blood flow velocities in splenic veins were(18.3±8.4)and(40.3±16.6)cm/s respectively.The inter-group differences were statistically significant(P=0.001,0.006).No significant differences existed in thickness of transplanted pancreatic head/body/tail,as well as blood flow velocity or resistance index in transplant pancreatic artery(P>0.05).Conclusions Fasting blood glucose,blood amylase,urine amylase,fatty acid and D-dimer are important and yet non-specific biochemical parameters in the diagnosis of pancreatic transplantation thrombosis.Color Doppler ultrasonography may provide valuable imaging diagnostic rationales for making an early diagnosis and providing timely interventions of transplanted pancreatic venous thrombosis post-SPK.It is imperative to enhance dynamic monitoring using color Doppler ultrasound within 1-2 weeks post-SPK.Greater attention should be paid to internal diameter and blood flow velocity of donor splenic vein.
作者
林岚
刘路浩
麦幸欢
黄洁芳
陈正
Lin Lan;Liu Luhao;Mai Xinghuan;Huang Jiefang;Chen Zheng(Department of Ultrasonic Diagnosis,Second Affiliated Hospital,Guangzhou Medical University,Guangzhou 510260,China;Organ Transplant Center,Second Affiliated Hospital,Guangzhou Medical University,Guangzhou 510260,China)
出处
《中华器官移植杂志》
CAS
2023年第12期743-749,共7页
Chinese Journal of Organ Transplantation
关键词
彩色多普勒超声
胰肾联合移植
移植胰
静脉血栓形成
Color Doppler ultrasonography
Simultaneous pancreas-kidney transplantation
Transplanted pancreas
Vein thrombosis
