螺旋CT测定肝脏体积评估乙型肝炎肝硬化患者肝脏储备功能的应用

doi:10.3969/j.issn.1672-5069.2020.05.027

摘要/Abstract

摘要： 目的运用螺旋CT扫描测定肝脏体积评估乙型肝炎肝硬化患者肝脏储备功能。方法 2016年6月～2020年2月我院诊治的乙型肝炎肝硬化患者60例,行CT增强扫描,应用法国Intrasense公司的Myrian XP Liver医学图像分析软件计算实际肝脏体积(PLV),并与理论肝脏体积(TLV)比较。根据肝脏CT表现,将肝硬化分为1～4级。结果本组肝硬化CT分级为1级12例,2级25,3级13例和4级10例; CT 1级患者PLV为(996.2±145.5)cm³,显著小于TLV【(1440.2±106.2)cm³, P<0.05】,2级患者PLV为(918.2±116.4)cm³,显著小于TLV【(1408.8±92.0)cm³,P<0.05】,3级患者PLV为(852.4±70.8)cm³,显著小于TLV【(1380.2±104.8)cm³,P<0.05】,4级患者PLV为(724.9±92.3)cm³,也显著小于TLV【(1352.1±88.2)cm³,P<0.05】;15例Child-Pugh A级患者PLV为(985.2±250.8)cm³,显著小于TLV【(1420.6±125.0)cm³,P<0.05】,31例B级患者PLV为(820.6±105.4)cm³,显著小于TLV 【(1381.8±110.8)cm³,P<0.05】,14例C级患者PLV为(704.6±70.5)cm³,显著小于TLV 【(1340.5±120.9)cm³,P<0.05】;14例MELD评分＜10分患者PLV为(960.6±162.5)cm³,显著小于TLV【(1408.2±92.8)cm³,P<0.05】,28例MELD评分为10～20分患者PLV为(842.6±90.6)cm³,显著小于TLV【(1372.4±108.0)cm³,P<0.05】,18例MELD评分＞20分患者PLV为(782.1±40.8)cm³,显著小于TLV 【(1325.0±130.8)cm³,P<0.05】。结论应用分析软件测定螺旋CT扫描获得的实际肝脏体积能够有效评价乙型肝炎肝硬化患者肝硬化程度及其储备功能,值得临床总结应用。

关键词: 肝硬化, CT扫描, 实际肝脏体积, 理论肝脏体积, 肝功能储备 , ,

Abstract: Objective The aim of this study was to evaluate hepatic functional reserve using practical liver volumes (PLV) measured by enhanced CT scan in patients with hepatitis B liver cirrhosis (LC). Methods A total of 60 patients with hepatitis B LC underwent spiral CT examination in our hospital between June 2016 and February 2020. The PLV was calculated by Myrian XP Liver software and compared to theoretical liver volumes (TLV). The LC was divided into four class based on CT imaging. Results The LC in our series was found to be class 1 in 12, class 2 in 25, class 3 in 13 and class 4 in 10; the PLV in patients with class 1 was (996.2±145.5)cm³, significantly smaller than TLV 【(1440.2±106.2)cm³, P<0.05】, the PLV in patients with class 2 was (918.2±116.4)cm³, significantly smaller than TLV【(1408.8±92.0)cm³, P<0.05】, the PLV in class 3 was (852.4±70.8)cm³, much smaller than TLV【(1380.2±104.8)cm³, P<0.05】 and the PLV in patients with class 4 was (724.9±92.3)cm³, significantly smaller than TLV【(1352.1±88.2)cm³, P<0.05】; the PLV in 15 patients with Child-Pugh class Awas (985.2±250.8)cm³, significantly smaller than TLV【(1420.6±125.0)cm³, P<0.05】, the PLV in 31 patients with class B was (820.6±105.4)cm³, significantly smaller than TLV 【(1381.8±110.8)cm³, P<0.05】 and the PLV in 14 patients with Child-Pugh class C was (704.6±70.5)cm³, significantly smaller than TLV 【(1340.5±120.9)cm³, P<0.05】; the PLV in 14 patients with MELD score less than 10 was (960.6±162.5)cm³, much smaller than TLV【(1408.2±92.8)cm³, P<0.05】, the PLV in 28 patients with MELD score of 10 to 20 was (842.6±90.6)cm³, significantly smaller than TLV【(1372.4±108.0)cm³, P<0.05】, and the PLV in 18 patients with MELD score greater than 20 was (782.1±40.8)cm³, significantly smaller than TLV 【(1325.0±130.8)cm³, P<0.05】. Conclusion The actual liver volume measured by spiral CT scan might effectively evaluate the functional reservoir in patients with hepatitis B liver cirrhosis, which warrants further clinical investigation.

Key words: Liver cirrhosis, Spiral CT scan, Practical liver volumes, Theoretical liver volumes, Liver reservoir

朱晓强, 江凯, 潘静. 螺旋CT测定肝脏体积评估乙型肝炎肝硬化患者肝脏储备功能的应用[J]. 实用肝脏病杂志, 2020, 23(5): 711-714.

Zhu Xiaoqiang, Jiang Kai, Pan Jing.. Evaluation of hepatic functional reserve using practical liver volumes measured by enhanced CT scan in patients with hepatitis B liver cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(5): 711-714.

参考文献

[1] Ni L, Li C, Li Y.Correlation of APOBEC3G expression with liver function indexes of patients with chronic hepatitis B and comparison in chronic hepatitis B, liver cirrhosis and liver cancer. Oncol Lett, 2020, 19(3):2562-2567.
[2] Sun A, Gao W, Xiao T.Autologous bone marrow stem cell transplantation via the hepatic artery for the treatment of hepatitis B virus-related cirrhosis: a PRISMA-compliant meta-analysis based on the Chinese population. Stem Cell Res Ther, 2020, 11(1):104.
[3] Zhong X, Tang H, Lu B, et al. Differentiation of small hepatocellular carcinoma from dysplastic nodules in cirrhotic liver: texture analysis based on MRI improved performance in comparison over gadoxetic acid-enhanced MR and diffusion-weighted imaging. Front Oncol, 2020, 9:1382.
[4] Yan LT, Wang LL, Yao J, et al.Total bile acid-to-cholesterol ratio as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with non-cholestatic chronic hepatitis B virus infection. Medicine (Baltimore), 2020, 99(8):e19248.
[5] Chen F,Chen YL,Chen TW,et al.Liver lobe based intravoxel incoherent motion diffusion weighted imaging in hepatitis B related cirrhosis: Association with Child-Pugh class and esophageal and gastric fundic varices. Medicine (Baltimore), 2020, 99(2):e18671.
[6] Brancaccio G, Fasano M, Grossi A, et al.Clinical outcomes in patients with hepatitis D, cirrhosis and persistent hepatitis B virus replication, and receiving long-term tenofovir or entecavir. Aliment Pharmacol Ther, 2019, 49(8):1071-1076.
[7] Chen PC, Chen BH, Huang CH, et al.Integrated model for end-stage liver disease may be superior to some other model for end-stage liver disease-based systems in addition to Child-Turcotte-Pugh and albumin-bilirubin scores in patients with hepatitis B virus-related liver cirrhosis and spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol, 2019, 31(10):1256-1263.
[8] Yang J, Yan B, Yang L, et al.Macrocytic anemia is associated with the severity of liver impairment in patients with hepatitis B virus-related decompensated cirrhosis: a retrospective cross-sectional study. BMC Gastroenterol, 2018, 18(1):161.
[9] 叶春辉, 徐邦浩, 文张, 等. 白细胞介素-6与联合肝脏分隔和门静脉结扎的二步肝切除术后剩余肝脏体积增生的相关性研究. 中华消化外科杂志, 2018, 17(12): 1187-1192.
[10] Nakagawa M, Namimoto T, Shimizu K, et al. Measuring hepatic functional reserve using T1 mapping of Gd-EOB-DTPA enhanced 3T MR imaging: A preliminary study comparing with⁹⁹mTc GSA scintigraphy and signal intensity based parameters. Eur J Radiol, 2017, 92:116-123.
[11] Pan S, Wang XQ, Guo QY, et al. Quantitative assessment of hepatic fibrosis in chronic hepatitis B and C: T1 mapping on Gd-EOB-DTPA-enhanced liver magnetic resonance imaging. World J Gastroenterol, 2018, 24(18):2024-2035.
[12] 胡剑飞, 雷正明, 谢云川, 等. CT灌注成像在术前评估原发性肝癌合并肝纤维化者肝储备功能中的价值初探. 中华普通外科学文献(电子版), 2010, 04(4), 355-359.
[13] 叶春辉, 徐邦浩, 文张, 等. 白细胞介素-6与联合肝脏分隔和门静脉结扎的二步肝切除术后剩余肝脏体积增生的相关性研究. 中华消化外科杂志, 2018, 17(12): 1187-1192.
[14] Li WX, Zhao XT, Chai WM, et al. Hepatitis B virus-induced liver fibrosis and cirrhosis: the value of liver and spleen volumetry with multi-detector spiral computed tomography. J Dig Dis, 2010, 11(4): 215-223.
[15] Taura T, Nakamura K, Takashima S, et al. Heterogeneity of hepatic parenchymal enhancement on computed tomography during arterial portography: quantitative analysis of correlation with severity of hepatic fibrosis. Hepatol Res, 2001, 20(2): 182-192.
[16] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015 年版). 实用肝脏病杂志, 2016, 19(3):389-400.
[17] NIanashima A, SumidaY, Abo T, et al. Surgical experiences of intraductal papillary mucinous neoplasms of the pancreas at a single Japanese institute: characteristics of malignant histology. Hepatogastroenterology, 2008, 55(88):2238-2241.
[18] Ogasawara K, Une Y, Nakajima Y. The significance of measuring liver volume using CT images before and after hepatectomy. Surg Today, 1995, 25: 43.
[19] Abdalla EK, Denys A, Chevalier P, et al. Total and segmental liver volume variations: implications for liver surgery. Surgery, 2004, 135(4): 404-410.
[20] Xu B, Liu J, Liu S, et al. Clinical effect of single covered stent and double covered stent on TIPS in the treatment of hemorrhage due to rupture of esophageal and gastric varices in cirrhosis and its influence on immune function. Exp Ther Med, 2019,18(6):4259-4264.
[21] Kwon AH, Matsui Y, Ha-Kawa SK, et al. Functional hepatic volume measured by technetium-⁹⁹m-galactosyl-human serum albumin liver scintigraphy: comparison between hepatocyte volume and liver volume by computed tomography. Am J Gastroenterol, 2001, 96(2): 541-546.