Abstract:

Analysis of compensation and related factors of accessory hepatic veins in Budd-Chiari   syndrome        DANG Xiao-wei, FU Kun-kun, LI Lin, et al. Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University, Budd-Chiari Syndrome Diagnosis and Treatment Center of Henan Province , Zhengzhou 450052, China
Corresponding author: DANG Xiao-wei, E-mail: dangxw1001@163.com
Abstract    Objective    To analyze the compensatory expansion of accessory hepatic vein(AHV) in patients with Budd-Chiari syndrome(B-CS), and to explore the possible factors and clinical significance of the expansion. Methods A retrospective analysis was conducted for the clinical data of 78 patients with B-CS in the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2016. The number and diameter of AHV were evaluated by color Doppler ultrasound. Two groups were divided according to the ultrasound results, the obviously compensatory expansion group (single maximum diameter ≥ 5 mm or total diameters ≥ 6 mm, n=58) and the non obviously compensatory expansion group (single maximum diameter ＜ 5 mm and total diameters ＜ 6 mm, n=20). The single diameter includes A type with diameter ≥ 5 mm and B type with diameter ＜5 mm. Patients' gender, age, type of B-CS, hepatic venous obstruction degree, prothrombin time (PT), Child-Pugh class, portal vein diameter, blood flow velocity of portal vein, the level of serum vascular endothelial growth factor (VEGF),  D-Dimer, fibrinogen and the angle between all of AHV's major axis and inferior vena cava(IVC) in two group were recorded. Results    Among the 78 patients of B-CS, 68 patients (87.2%) had AHV. There were 124 AHV in total (A type 96,B type 28). There were significant differences in the type of disease ［main hepatic vein(MHV)  3(5. %2) vs. 1(5.0%), inferior vena cava (IVC) 0 vs. 4(20.0), Mix 55(94.8) vs. 15 (75.0), P=0.007］, the degree of obstruction of the MHV ［ Ⅰ0 vs. 2 (10.0%),Ⅱ0 vs. 2 (10.0%), Ⅲ 6 (10.3%) vs. 10 (50.0%), Ⅳ 52 (89.7%) vs. 6 (30.0%), Z=-5.378, P=0.000］ and serum VEGF level ［（68.1±40.4）ng/L vs. （394.2±194.6）ng/L，t=-7.437，P=0.000］ between two groups (P＜0.05); There was no statistical significance in the gender (χ2=0.027), age (t=0.960), PT (t=-0.020), Child-Pugh class (Z=-0.564), portal vein diameter (t=1.586), blood flow velocity of portal vein (t=0.154), serum D-Dimer level (t=0.166) and  fibrinogen level (t=-1.562) between two group (P＞0.05). The angle between accessory hepatic vein's major axis and IVC between two types of AHV had statistical significance  (χ2=15.827, P=0.000). The total diameter of AHV had a positive correlation with the obstructive degree of MHV (r=0.657, P=0.000), and had a negative correlation with the level of serum VEGF (r=-0.725, P=0.000). The obstructive degree of MHV had a negative correlation with the level of serum VEGF (r=-0.445, P=0.000), too. Conclusion    Most of B-CS patients have the compensatory expansion of AHV, which is associated with the type of B-CS, the obstructive degree of MHV and the serum VEGF level,and might be related to the angle between accessory hepatic vein and IVC.

Key words: accessory hepatic vein, Budd-Chiari syndrome, compensatory expansion

摘要：

目的    分析布-加综合征病人副肝静脉（AHV）的代偿扩张情况，并对其可能的影响因素及其临床意义进行探讨。方法    分析2015年1月至2016年12月郑州大学第一附属医院78例布-加综合征病人的临床资料，应用彩色多普勒超声评估病人首次确诊时AHV的数目及其直径大小，根据结果分为明显代偿扩张组（AHV单支最大直径≥5 mm或AHV直径总和≥6 mm，n=58）和无明显代偿扩张组（AHV单支最大直径＜5 mm且AHV直径总和＜6 mm，n=20），同时将检出的AHV按直径大小分为A类（直径≥5 mm）和B类（直径＜5 mm）。分别记录分析两组病人的性别、年龄、疾病类型、肝静脉梗阻程度、凝血酶原时间（PT）、Child-Pugh分级、门静脉主干内径、门静脉入肝血流流速、血清血管内皮生长因子（VEGF）、D-二聚体、纤维蛋白原水平以及两类AHV长轴与下腔静脉（IVC）近心段长轴夹角。结果    78例布-加综合征病人中有68例（87.2%）检出AHV，共124支（A类96支，B类28支）。明显代偿扩张组和无明显代偿扩张组病人在疾病类型［主肝静脉（MHV）梗阻型3例（5.2%）vs. 1例（5.0%）, IVC梗阻型0 vs. 4例（20.0%）, 混合型55例（94.8%）vs. 15例（75.0%），P=0.007］、MHV梗阻程度［Ⅰ度0 vs. 2例（10.0%），Ⅱ度0 vs. 2例（10.0%），Ⅲ度6例（10.3%）vs. 10例（50.0%），Ⅳ度52例（89.7%） vs. 6例（30.0%），Z=-5.378，P=0.000］、血清VEGF水平［（68.1±40.4）ng/L vs. （394.2±194.6）ng/L，t=-7.437，P=0.000］方面比较，差异有统计学意义（P＜0.05）。两组病人的性别（χ2=0.027）、年龄（t=0.960）、PT（t=-0.020）、Child-Pugh分级（Z=-0.564）、门静脉主干内径（t=1.586）、门静脉入肝血流流速（t=0.154）、血清D-二聚体（t=0.166）、纤维蛋白原水平（t=-1.562）差异均无统计学意义（均P＞0.05）。两类AHV长轴与IVC近心段长轴夹角存在差异（χ2=15.827，P=0.000）。两组病人AHV直径总和与MHV梗阻程度呈正相关（r=0.657，P=0.000），与血清VEGF水平呈负相关（r=-0.725，P=0.000），MHV梗阻程度与血清VEGF水平也呈负相关（r=-0.445, P=0.000）。结论    布-加综合征病人的AHV多代偿性扩张，其扩张情况与疾病类型、MHV梗阻程度、血清VEGF水平有关。AHV长轴与IVC近心段长轴夹角是代偿扩张的可能影响因素。

关键词: 副肝静脉, 布-加综合征, 代偿性扩张