定量磁共振成像诊断原发性胆汁性肝硬化患者门静脉高压症价值分析*

doi:10.3969/j.issn.1672-5069.2020.04.029

摘要/Abstract

摘要： 目的探讨应用定量MRI和血清学指标诊断原发性胆汁性肝硬化(PBC)患者门静脉高压症的价值。方法 2010年1月～2018年12月我院收治的PBC患者45例,获得并计算天门冬氨酸氨基转移酶/血小板比值指数(APRI)和纤维化指数-4(FIB-4)评分,行腹部磁共振成像检查,提取肝脾硬度、T1、T2和表观弥散系数(ADC)值,绘制受试者工作特征曲线下面积(AUC),分析各指标诊断门静脉高压症的效能。结果在45例PBC患者中,发现14例(31.1%)存在门静脉高压症;14例门静脉高压症患者APRI评分为2.21(1.82,2.74)分,FIB-4评分为1.65(1.02,1.94)分,肝脏硬度为4.87(4.15,5.46)kPa,脾脏硬度为9.75(7.54,11.77)kPa,肝脏T1为1024.8(975.4,1078.5)ms,肝脏T2为62.7(57.4,68.4)ms,ADC值为1.29(1.11,1.62)×10^-3mm²/s,显著高于31例无门静脉高压症患者[分别为0.68(0.21,0.94)分、0.24(0.18,0.42)分、2.51(2.11,2.98)kPa、5.23(4.62,6.08)kPa、930.8(870.9,980.4)ms、56.8(55.3,58.7)ms和1.08(1.02,1.25)×10^-3mm²/s,P<0.05];APRI、FIB-4、MR检测肝硬度和脾硬度诊断门脉高压的灵敏度分别为90.4%、82.3%、92.4%和90.3%,特异度分别为79.6%、91.2%、92.0%和93.2%。结论采用MRI检测肝脾硬度联合APRI和FIB-4评分可以帮助诊断PBC患者门静脉高压症,值得临床进一步验证。

关键词: 原发性胆汁性肝硬化, 门静脉高压症, 定量磁共振成像, 肝脏硬度, 天冬氨酸氨基转移酶/血小板比值指数, 诊断

Abstract: Objective The aim of this study was to investigate the clinical value of quantitative MRI and serological indexes in the diagnosis of portal hypertension (PH) in patients with primary biliary cirrhosis (PBC). Methods Forty-five patients with PBC were admitted to our hospital from January 2010 through December 2018. The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) were obtained. All patients with PBC underwent MRI examination. The receiver-operating characteristic curve (ROC curve) was drawn to analyze the diagnostic value of quantitative MRI index, APRI and FIB-4 for portal hypertension diagnosis. Results 14 (31.1%) patients with PBC in our series had PH; in the 14 patients with PH, the APRI score was 2.21(1.82,2.74), FIB-4 score was 1.65(1.02,1.94), liver stiffness was 4.87(4.15, 5.46)kPa, spleen stiffness was 9.75(7.54, 11.77)kPa, T1 of liver was 1024.8(975.4, 1078.5)ms, T2 of liver was 62.7(57.4, 68.4)ms, and ADC was 1.29(1.11, 1.62)×10^-3mm²/s, significantly higher than 0.68(0.21, 0.94), 0.24(0.18, 0.42), 2.51(2.11, 2.98)kPa, 5.23(4.62, 6.08)kPa, 930.8(870.9, 980.4)ms, 56.8(55.3, 58.7)ms and 1.08(1.02, 1.25)×10^-3mm²/s in 31 patients without PH (P<0.05); the sensitivity by APRI, FIB-4, liver and spleen stiffness by MR determination in diagnosing PH were 90.4%, 82.3%, 92.4% and 90.3%, and the specificity were 79.6%, 91.2%, 92.0% and 93.2%, respectively. Conclusion The serological indexes and liver and spleen stiffness determined by MRI might help judge the existence of portal hypertension in patients with PBC, which needs further investigation.

Key words: Primary biliary cirrhosis, Portal hypertension, Quantitative magnetic resonance imaging, Liver stiffness, Aspartate aminotransferase-to-platelet ratio index, Diagnosis

宋丽俊, 袁雁, 王伟. 定量磁共振成像诊断原发性胆汁性肝硬化患者门静脉高压症价值分析^*[J]. 实用肝脏病杂志, 2020, 23(4): 568-571.

Song Lijun, Yuan Yan, Wang Wei. Clinical value of quantitative magnetic resonance imaging in the diagnosis of portal hypertension in patients with primary biliary cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(4): 568-571.

参考文献

[1]Deneau M, Jensen MK, Holmen J, et al. Primary sclerosing cholangitis, autoimmune hepatitis, and overlap in Utah children: epidemiology and natural history. Hepatology, 2013, 58:1392–1400.
[2]Singh H, Balouch F, Noble C, et al. Evolving practice and changing phenotype in pediatric autoimmune liver disease: outcomes from an Australian center. J Pediatr Gastroenterol Nutr, 2018, 67:80–85.
[3]Sun M, Kisseleva T. Reversibility of liver fibrosis. Clin Res Hepatol Gastroenterol, 2015,39:S60–S63.
[4]Deneau MR, El-Matary W, Valentino PL, et al. The natural history of primary sclerosing cholangitis in 781 children: a multicenter, international collaboration. Hepatology, 2017, 66:518–527.
[5]Bloom S, KempW, Lubel J. Portal hypertension: pathophysiology, diagnosis and management. Intern Med J, 2015, 45:16–26.
[6]Brancatelli G, Federle MP, Ambrosini R, et al. Cirrhosis: CT and MR imaging evaluation. Eur J Radiol, 2007, 61:57–69.
[7]Trout AT, Sheridan RM, Serai SD, et al. Diagnostic performance of MR elastography for liver fibrosis in children and young adults with a spectrum of liver diseases. Radiology, 2018, 2018:172099.
[8]Banerjee R, Pavlides M, Tunnicliffe EM, et al. Multiparametric magnetic resonance for the non-invasive diagnosis of liver disease. J Hepatol, 2014, 60:69–77.
[9]GuimaraesAR, Siqueira L, Uppal R, et al. T2 relaxation time is related to liver fibrosis severity. Quant Imaging Med Surg, 2016, 6: 103–114.
[10]Koinuma M, Ohashi I, Hanafusa K, et al. Apparent diffusion coefficient measurements with diffusion-weighted magnetic resonance imaging for evaluation of hepatic fibrosis. J Magn Reson Imaging, 2005, 22:80–85.
[11]Yin M, Glaser KJ, Talwalkar JA, et al. Hepatic MR elastography: clinical performance in a series of 1,377 consecutive examinations. Radiology, 2016, 278:114–124.
[12]Li J, Gordon SC, Rupp LB, et al. Chronic Hepatitis Cohort Study (CHeCS) Investigators. The validity of serum markers for fibrosis staging in chronic hepatitis B and C. J Viral Hepat, 2014, 21(12): 930-937.
[13]Xiao GQ, Yang JY, Yan LA. Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis. Hepatology, 2015, 61(1):292-302.
[14]Xiao G, Zhu F, Wang M, et al. Diagnostic accuracy of APRI and FIB-4 for predicting hepatitis B virus-related liver fibrosis accompanied with hepatocellular carcinoma. Dig Liver Dis, 2016, 48(10):1220-1226.
[15]中华医学会肝病学分会、消化病学分会、感染病学分会.胆汁淤积性肝病诊断和治疗共识(2015年).实用肝脏病杂志,2016,19(6):Ⅰ-ⅩⅠ.
[16]Manns MP,Czaja AJ,Gorham JD,et al. Diagnosis and management of autoimmune hepatitis. Hepatology,2010,51:2193-2213.
[17]Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology, 2003, 38(2):518-526.
[18]Sterling RK, Lissen E, Clumeck N,et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology, 2006, 43(6):1317-1325.
[19]Kim HY, Cho EJ, Chun S, et al. Red blood cell alloimmunization in Korean patients with myelodysplastic syndrome and liver cirrhosis. Ann Lab Med, 2019,39(2):218-222.
[20]Fortea JI, Puente Á, Ruiz P,et al. Impact of an acute hemodynamic response-guided protocol for primary prophylaxis of variceal bleeding. World J Clin Cases, 2018,6(13):611-623.
[21]Maslennikov R, Driga A, Ivashkin K, et al. NT-proBNP as a biomarker for hyperdynamic circulation in decompensated cirrhosis. Gastroenterol Hepatol Bed Bench,2018,11(4):325-332.
[22]Landeira G, Morise S, Fassio E, et al. Effect of cirrhosis at baseline on the outcome of type l autoimmune hepatitis. Ann Hepatol, 2012, 11(1):100-106.
[23]Gao YH, Wang JY, Liu PY, et al. Iron metabolism disorders in patients with hepatitis B-related liver diseases. World J Clin Cases, 2018,6(13):600-610.
[24]Lee NCW, Carella MA, Papa S,et al. High expression of glycolytic genes in cirrhosis correlates with the risk of developing liver cancer. Front Cell Dev Biol, 2018,6:138.
[25]Ronot M, Lambert S, Elkrief L, et al. Assessment of portal hypertension and high-risk oesophageal varices with liver and spleen three-dimensional multifrequency MR elastography in liver cirrhosis. Eur Radiol, 2014, 24:1394–1402.

定量磁共振成像诊断原发性胆汁性肝硬化患者门静脉高压症价值分析^*

Clinical value of quantitative magnetic resonance imaging in the diagnosis of portal hypertension in patients with primary biliary cirrhosis

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