Prognostic value of Doppler-ultrasonography in hepatic vend-occlusive disease - A study of 71 children

被引:51
作者
Lassau, N
Auperin, A
Leclere, J
Bennaceur, A
Valteau-Couanet, D
Hartmann, O
机构
[1] Inst Gustave Roussy, Unit Ultrasonog, Dept Med Imaging, F-94805 Villejuif, France
[2] Inst Gustave Roussy, Dept Stat, F-94805 Villejuif, France
[3] Inst Gustave Roussy, Dept Biol, F-94805 Villejuif, France
[4] Inst Gustave Roussy, Pediat Bone Marrow Transplantat Unit, F-94805 Villejuif, France
关键词
D O I
10.1097/00007890-200207150-00011
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Currently, the severity of veno-occlusive disease (VOD) is graded retrospectively on the basis of the evolution of clinical and biological criteria. The objective of this study was to describe a non-invasive method capable of predicting the severity of this disease at the time of the diagnosis. Methods. Seventy-one children who developed VOD after intensive myeloablative therapy with busulfan before hematopoietic stem cell transplantation were included in this study. Sixty-four patients underwent baseline ultrasonography (US) and Doppler examination before transplantation. All patients had posttransplantation US and Doppler examinations at the time of the clinical and biological diagnosis of VOD. Seven US morphological criteria and seven Doppler criteria were studied that yielded three individual scores: a US score, a Doppler score, and a total Doppler ultrasonography (DUS) score. Results. In the univariate analysis, three of 7 US criteria, three of 7 Doppler criteria, and the three scores were correlated with the severity of VOD after transplantation and at the time of the diagnosis. In the multivariate analysis, two US criteria (splenomegaly and ascites) and one Doppler criterion (flow recorded in para-umbilical vein) were correlated with the severity of VOD. The multivariate analysis of the pooled US and Doppler criteria showed that the flow recorded in the para-umbilical vein was the only criterion significantly associated with the grade of VOD (P=0.0001). All patients with a US-Doppler score >9 developed grade 2 or 3 VOD. Conclusion. Postgraft US and Doppler examinations have a prognostic significance according to the grade of VOD.
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页码:60 / 66
页数:7
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