간경변증 환자에서 도플러를 이용한 복부혈역학검사값의 초음파 장비 간 차이
Interequipment Variability of Doppler Ultrasonographic Indices in Patients with Liver Cirrhosis
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목적: 도플러초음파는 비침습적 검사법이라는 장점을 가져 복강 혈관의 혈역학 연구에 널리 사용되어 왔다. 그러나 검사 장비 상호 간에 도플러 측정값의 차이가 있다면 그 결과를 혈역학 연구나 임상에 적용하는 데 제한이 될 수 있다. 본 연구는 간경변의 복부혈역학 측정에 도플러초음파의 장비 간 차이가 있는지 살펴봄으로써, 간경변증 환자에 대한 혈역학 연구에 각기 다른 초음파를 사용하여 측정한 결과를 호환하여 적용하는 것이 적절한지 알아보고자 했다. 대상과 방법: 총 30명의 간경변증 환자를 대상으로 두 종류의 초음파 장비를 이용하여 간문맥의 평균 혈류속도, 직경, 혈류량, 울혈지수(congestion index), 그리고 비장정맥의 평균 혈류속도, 직경, 혈류량을 각 각 측정하여 비교 분석하였다. 초음파 장비로는 HDI-5000 (Philips, Bothell WA, USA)과 SSD-5000 (Aloka, Tokyo, Japan)를 사용하였다. 결과: 간문맥 평균 혈류속도는 HDI-5000과 SSD-5000에서 각각 8.72±3.69 cm/sec, 12.21±2.84 cm/sec로 의미 있는 차이를 보였다(P<0.001). 간문맥 혈류량 또한 HDI-5000은 533.77±325.87 mL/min, SSD-5000은 771.69±315.69 mL/min으로 HDI-5000 장비에서 낮았고, 울혈지수 역시 HDI-5000과 SSD-5000에서 각각 0.13±0.06 cm×sec, 0.09±0.03 cm×sec으로 두 장비 간 차이가 있었다(P<0.01). 비장정맥 혈류속도는 HDI-5000과 SSD-5000에서 각각 8.55±2.71 cm/sec, 12.32±3.11 cm/sec (P<0.001), 그리고 혈류량은 각각 390.73±260.98 mL/min, 595.01±346.53 mL/min으로 두 장비 간에 통계적인 차이가 있었다(P=0.015). 그러나 간문맥 직경 및 비장정맥 직경의 측정은 양기계 간 차이가 없었다. 결론: 간문맥의 평균 혈류속도, 혈류량, 울혈지수, 그리고 비장정맥의 평균 혈류속도, 혈류량 등은 초음파 장비 간에 의미 있는 차이를 보이므로, 간경변증 환자에서 복부혈역학의 연구와 추적 검사에 서로 다른 장비를 사용하여 측정한 도플러 값들을 호환 적용하는 것은 바람직하지 않다.
Abstract
Doppler ultrasongraphy is used to evaluate hemodynamic alternations in patients with liver cirrhosis. Purpose of this study was to determine the interequipment variability of Doppler indices in portal and splenic vein in cirrhosis. Methods: Blood velocity, diameter, flow and congestive index in portal and splenic vein were measured by Doppler ultrasonography in 30 patients with cirrhosis using two different machines. Results: Portal venous velocities measured by HDI-5000 and SSD-5000 were 8.72±3.69 cm/sec, 12.21±2.84 cm/sec, respectively which showed significant difference (P<0.001). Measured portal blood flows and congestive indices also had significant difference between HDI-5000 and SSD-5000 (P<0.01). Splenic venous velocity by HDI-5000 was 8.55±2.71 cm/sec, which was lower than that of 12.32±3.11 cm/sec by SSD- 5000 (P<0.001). Splenic blood flows measured by HDI-5000 and SSD-5000 were 390.73±260.98 mL/min, 595.01±346.53 mL/min, respectively, showing significant difference (P=0.015). However, no differences were in the diameters of portal and splenic vein between HDI-5000 and SSD-5000. Conclusion: Doppler indices in portal and splenic vein showed significant interequipment variability. Therefore, in liver cirrhosis, hemodynamic investigations using different Doppler ultrasonographic machines is inappropriate.
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