血吸虫病性肝硬化患者腹部CT表现和CT定量参数特征观察*

doi:10.3969/j.issn.1672-5069.2021.05.010

摘要/Abstract

摘要： 目的探讨血吸虫病性肝硬化患者腹部电子计算机断层扫描(CT)表现和CT定量参数特征。方法 2018年5月～2020年5月我院收治的血吸虫病性肝硬化患者72例,其中Child-Pugh A级26例、Child-Pugh B级21例和Child-Pugh C级25例,另选择同期于我院健康体检者25名。使用飞利浦64排CT行上腹部平扫和增强扫描,选择感兴趣区,获取肝灌注参数血容量(BV)、血流量(BF)、平均通过时间(MTT)、肝动脉分数(HAF)和肝动脉灌注量(HAP)。结果 72例血吸虫病性肝硬化患者出现较典型的肝硬化CT表现、肝功能损伤的血生化学改变和脾功能亢进症表现;健康人腹部CT灌注参数BV、BF、MTT、HAF和HAP分别为(47.3±8.2)ml/100g、(211.9±42.1)ml/min/100g、(12.9±3.1)s、(0.2±0.0)和(16.3±7.9)ml/min/100g,Child-Pugh A级患者分别为(40.8±7.6)ml/100g、(183.1±37.2)ml/min/100g、(15.8±3.7)s、(0.3±0.0)和(19.1±8.8)ml/min/100g,Child-Pugh B级患者分别为(35.5±6.9)ml/100g、(124.7±33.2)ml/min/100g、(19.2±4.5)s、(0.3±0.0)和(24.5±9.9)ml/min/100g,Child-Pugh C级患者分别为(24.8±8.4)ml/100g、(115.5±28.1)ml/min/100g、(24.6±5.5)s、(0.4±0.1)和(33.5±12.5)ml/min/100g,各组间差异显著(P<0.05)。结论对血吸虫病性肝硬化患者行CT检查能够了解肝脾形态学改变信息,测量CT灌注参数也能够为评估肝硬化的严重程度提供参考依据。

关键词: 肝硬化, 血吸虫病, 64排螺旋CT, 灌注成像

Abstract: Objective The purpose of this study was to investigate the abdominal computed tomography (CT) manifestations and CT quantitative parameters in patients with schistosomiasis liver cirrhosis (SLC). Methods A total of 72 patients with SLC and 25 healthy volunteers were enrolled in this study between May 2018 and May 2020. The patients with SLC included Child-Pugh class A in 26, Child-Pugh class B in 21, and Child-Pugh class C in 25. All the individuals underwent CT enhanced scan, and the blood volume (BV), blood flow (BF), mean transit time (MTT) , hepatic arterial fraction (HAF) and hepatic artery perfusion (HAP) were recorded. The laboratory indicators, such as total serum bilirubin, albumin, international standardized ratio of prothrombin time, white blood cell counts and platelet counts were detected. Results TheCT examination in 72 patients with SLC showed abnormal ratio of liver lobes, irregular contour and widening of liver fissure, a map-like, diffuse decrease of liver parenchyma density, high density schistosomia-like calcified nodules and portal vein dilatation in liver, portal vein and mesenteric vein, and the blood analysis demonstrated the injured liver function tests and hypersplenism; in healthy subjects,the abdominal CT perfusion parameters, e.g. the BV, BF, MTT, HAF and HAP levels were (47.3±8.2) ml/100g, (211.9±42.1) ml/min/100g, (12.9±3.1) s, (0.2±0.0) and (16.3±7.9) ml/min/100g, respectively, those in patients with SLC of Child-Pugh class A were (40.8±7.6) ml/100g, (183.1±37.2) ml/min/100g, (15.8±3.7) s, (0.3±0.0) and (19.1±8.8) ml/min/100g, in patients with Child-Pugh class B were (35.5±6.9) ml/100g, (124.7±33.2) ml/min/100g, (19.2±4.5) s, (0.3±0.0) and (24.5±9.9) ml/min/100g, and in patients with Child-Pugh class C were (24.8±8.4) ml/100g, (115.5±28.1) ml/min/100g, (24.6±5.5) s, (0.4±0.1) and (33.5±12.5) ml/min/100g, respectively, significantly different among them (P＜0.05). Conclusion The CT examination of liver in patients with SLC could show the morphological changes, and the CT perfusion parameters obtained might help evaluate the severity of liver injuries.

Key words: Liver cirrhosis, Schistosomiasis japonica, 64-slice spiral CT scan, Perfusion imaging

叶莉, 吴晨颖, 宋斌. 血吸虫病性肝硬化患者腹部CT表现和CT定量参数特征观察^*[J]. 实用肝脏病杂志, 2021, 24(5): 645-648.

Ye Li, Wu Chenying, Song bin. Abdominal CT manifestations and CT quantitative parameters in patients with schistosomiasis cirrhosis[J]. Journal of Practical Hepatology, 2021, 24(5): 645-648.

参考文献

[1]Nakashima T , Okuda K , Kojiro M , et al. Primary liver cancer coincident with schistosomiasis japonica. A study of 24 necropsies. Cancer, 2015, 36(4):1483-1489.
[2]Gonçalves-Macedo H, Liana, Lopes E P , Domingues A L C , et al. Schistosomiasis and hepatopulmonary syndrome: the role of concomitant liver cirrhosis. Mem Ins Oswaldo Cruz, 2017, 112(7):469-473.
[3]Marques Chaves D , Sakai P , Mucenic M , et al. Comparative study of portal hypertensive gastropathy in schistosomiasis and hepatic cirrhosis. Endoscopy, 2002, 34(3):199-202.
[4]王瑜, 夏超明. 可诱导共刺激分子/可诱导共刺激分子配体信号通路对血吸虫肝纤维化的影响. 中华传染病杂志, 2015, 33(2):96-101.
[5]Huber A , Ebner L , Montani M , et al. CT Detection of Liver fibrosis in a potentially reversible pre-cirrhotic stage. Gene Dev, 2012, 26(7):705-713.
[6]Lamb P , Sahani D V , Fuentes-Oreego J , et al. Stratification of patients with liver fibrosis using dual-energy CT. IEEE Trans Med Imaging, 2014, 34(3):807-815.
[7]Talaki E , Schaffellner S , Kniepeiss D , et al. CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension? Eur Radiol, 2017, 27(10):4173-4180.
[8]Ma ZY, Liu KW. Sorafenib and praziquantel synergistically attenuate schistosoma japonicum-induced liverfibrosis in mice. Parasitol Res, 2018, 117(9):2831-2839.
[9]Beem H V , Manger F W , Boxtel C V , et al. Etomidate anaesthesia in patients with cirrhosis of the liver: pharmacokinetic data. Anaesthesia, 2015, 38(1):61-62.
[10] Kew M C , Geddes E W , Macnab G M , et al. Hepatitis-B antigen and cirrhosis in bantu patients with primary liver cancer. Cancer, 2015, 34(3):539-541.
[11] Keller A Z . Cirrhosis of the Liver, Alcoholism and heavy smoking associated with cancer of the mouth and pharynx. Cancer, 2015,20(6):1015-1022.
[12] 刘铁, 宋敏芳, 董吉顺,等. 慢性血吸虫病腹部CT及病理对照研究. 中华放射学杂志, 2005, 39(11):1188-1191.
[13] Ohmae H , Sy O S , Chigusa Y , et al. Imaging diagnosis of schistosomiasis japonica—the use in japan and application for field study in the present endemic area. Parasitol Int, 2003, 52(4):385-393.
[14] Hayashi S , Ohtake H , Koike M . Laparoscopic diagnosis and clinical course of chronic schistosomiasis japonica. Acta Trop, 2000, 77(1):133-140.
[15] 王宇军, 胡利荣, 程有根,等. 血吸虫性膀胱炎的CT表现. 中华放射学杂志, 2014, 48(2):132-134.
[16] Zhong Z R , Zhou H B , Li X Y , et al. Serological proteome-oriented screening and application of antigens for the diagnosis of Schistosomiasis japonica. Acta Trop, 2010, 116(1):1-8.
[17] 曾艳妮, 韩军, 刘良进,等.不同Child-Pugh分级的血吸虫病性肝硬化患者肝脏CT灌注成像参数分析.实用肝脏病杂志,2020,23(5):691-694.
[18] Fischer M A , Brehmer K , Svensson A , et al. Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension. Eur Radiol, 2016, 26(11):4030-4036.
[19] Boas F E , Kamaya A , Do B , et al. Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans. J Digit Imaging, 2015, 28(2):213-223.
[20] 杨华伟, 刘剑仑, 苏丹柯,等. 肝癌伴肝硬化多层螺旋CT灌注成像的研究. 中华肿瘤防治杂志, 2010, 17(5):374-377.

血吸虫病性肝硬化患者腹部CT表现和CT定量参数特征观察^*

Abdominal CT manifestations and CT quantitative parameters in patients with schistosomiasis cirrhosis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	吴晓枫, 黄怡, 杨如杏, 邓少东, 张静莹, 官成浓, 王颖. 原发性胆汁性肝硬化患者外周血丝氨酸蛋白酶抑制剂A1基因多态性分析^*[J]. 实用肝脏病杂志, 2021, 24(6): 855-858.
[2]	石翠翠, 刘彦君, 章瑞南, 李光明, 范建高. 肝硬化患者血脂异常分析^*[J]. 实用肝脏病杂志, 2021, 24(6): 859-862.
[3]	柳梅, 时永红, 郇娟, 陈茂丽. 失代偿期肝硬化患者并发医院内感染病原菌类别及其耐药特点分析^*[J]. 实用肝脏病杂志, 2021, 24(6): 863-866.
[4]	刘玉玲, 甄增国, 王慧娟, 万秀敏, 郭振凯. 益生菌制剂对肝硬化并发自发性细菌性腹膜炎患者肠道屏障功能的影响^*[J]. 实用肝脏病杂志, 2021, 24(6): 867-870.
[5]	邢莉, 杜倩影, 姜艳丽, 韩冬. 分段注射对比剂CT增强扫描提高乙型肝炎肝硬化患者肝静脉显影效果研究^*[J]. 实用肝脏病杂志, 2021, 24(6): 871-874.
[6]	黄力鸥, 吴春荣, 徐丹, 崔宇慧, 唐建国. 无肝素化连续性肾脏替代治疗肝硬化并发肝性脑病患者疗效研究^*[J]. 实用肝脏病杂志, 2021, 24(6): 875-878.
[7]	叶东, 张俊霞, 李洁, 刘颖, 张丹, 郭永泽. 内镜下食管静脉曲张套扎术治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者再出血风险观察^*[J]. 实用肝脏病杂志, 2021, 24(6): 879-882.
[8]	韩成美, 韩永峰, 王春华. 乙型肝炎肝硬化患者并发急性肾损伤危险因素分析^*[J]. 实用肝脏病杂志, 2021, 24(6): 883-886.
[9]	王菁, 毕宁, 方亮, 田园. 自体骨髓干细胞经肝动脉肝内移植治疗失代偿期乙型肝炎肝硬化患者疗效研究[J]. 实用肝脏病杂志, 2021, 24(6): 887-890.
[10]	薛魁, 徐银海, 张健. 慢性乙型肝炎和乙型肝炎肝硬化患者血清血小板生成素水平变化及其临床意义^*[J]. 实用肝脏病杂志, 2021, 24(6): 891-894.
[11]	韩利畴, 许望, 韩丹, 邢增珀. 慢性乙型肝炎和乙型肝炎肝硬化患者胃粘膜病变研究[J]. 实用肝脏病杂志, 2021, 24(6): 895-898.
[12]	束青华, 张楠楠, 葛勇胜. 不同HCV基因型感染的慢性丙型肝炎和肝硬化患者对重组人干扰素α-2a治疗应答的影响[J]. 实用肝脏病杂志, 2021, 24(6): 899-902.
[13]	邓江, 石娟娟, 党双锁. 男性慢性肝病患者勃起功能障碍研究进展^*[J]. 实用肝脏病杂志, 2021, 24(6): 934-937.
[14]	赵剑波, 谭卿. 非肝硬化性门静脉高压症研究进展[J]. 实用肝脏病杂志, 2021, 24(5): 613-616.
[15]	谭风雷, 吴亮亮, 邓泽润, 徐峥, 张洁, 张跃新. 夜间加餐对肝硬化患者影响的Meta分析[J]. 实用肝脏病杂志, 2021, 24(5): 625-628.