CT肝脏体积测量在乙肝后肝硬化程度和肝功能状态评估中的应用研究

发布时间：2018-03-01 21:42

本文关键词： 乙肝后肝硬化组织病理学分级临床分期 Child-Pugh分级 MELD评分　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：1研究背景与目的乙肝后肝硬化是肝纤维化的终末阶段,它的程度轻重以及硬化肝的功能状态,对于患者的生存和预后十分重要。在肝硬化程度评判方面,肝活检术是金标准;在肝功能状态评估方面,临床上常将肝硬化分为代偿期和失代偿期,另外Child-Pugh分级和MELD评分也应用已久。但是,以上方法均存在或多或少的不足,亟待寻找新的手段来更好地评估肝硬化程度和肝功能状态。在近年文献报道的各种评估方法中,多层螺旋CT可精确测量活体肝脏体积,而肝脏体积变化是乙肝后肝硬化最基本的病理变化之一。但体积变化与组织学变化和功能学变化的相关关系怎样,肝脏体积测量可否作为诊断肝硬化严重程度的一个量化指标,目前在这方面的文献报道较少,并且在方案设计中多无同步进行组织病理学分级对比内容。本研究通过探讨CT肝脏体积测量与肝脏组织病理学分级、肝硬化临床分期、Child-Pugh分级和MELD评分的关系,评估CT肝脏体积测量在肝硬化程度和肝功能状态量化诊断中的价值。2方法收集2012年1月～2014年6月在南方医科大学南方医院住院治疗、并且在住院期间接受了肝组织活检术的乙型肝炎后肝硬化病例。经过纳入标准和排除标准筛选,最后获得符合本研究条件的患者共30例。收集的临床资料包括白蛋白、谷丙转氨酶、谷草转氨酶、凝血酶原时间的国际标准化比值、血小板计数、血肌酐。术前1周内行胃镜检查明确有无食道胃底静脉曲张,行腹部B超明确腹水情况。肝活检术前1周内采用64层螺旋CT薄层+三期增强扫描,获得的图像导入Mimics10.01软件,进行肝脏三维重建,并计算CT肝脏体积。同时,根据《Baveno Ⅳ门脉高压诊断和治疗共识》的标准对患者进行肝硬化临床分期。在术前48小时内,根据Child-Pugh评分标准和终末期肝病模型评分标准对患者进行Child-Pugh分级和MELD评分。肝活检术后,根据Laennec组织学分级标准进行病理分级。分析各Laennec分级、临床分期、Child-Pugh分级、MELD评分组之间的CT肝脏体积是否存在差异,以及前述分级/分期系统与CT肝脏体积的相关性。3结果30例患者的CT肝脏体积与理论肝脏体积相比较,前者显著小于后者(P0.05)。CT肝脏体积变化与肝脏组织病理学分级、肝硬化临床分期和MELD评分的变化均呈显著性负相关(P0.01),相关系数(r)分别为-0.55、-0.78及-0.52;与Child-Pugh分级无明显相关性(r=-0.34)。各Laennec分级、临床分期、Child-Pugh分级、MELD评分组之间的CT肝脏体积,组间差异均有显著性(P0.05);Child-Pugh A和B级组的CT肝脏体积差异无统计学意义(P0.05)。4结论乙肝后肝硬化患者的CT肝脏体积测量可以作为肝硬化的程度和功能状态的一个量化诊断和评估指标。
[Abstract]:1 background and objective liver cirrhosis is the end stage of liver fibrosis, its functional status and severity of liver cirrhosis, is very important for the survival and prognosis of patients with liver cirrhosis. In the evaluation, liver biopsy is the gold standard in the assessment of liver function; clinical aspects, often divided into liver cirrhosis during compensatory and in addition, Child-Pugh grading and MELD is used for a long time. However, these methods have some drawbacks, need to find new ways to better assess the degree of liver cirrhosis and liver function. In the various evaluation methods reported in the literature in recent years, multi-slice spiral CT can accurately measure the liver volume. The changes in liver volume is one of the basic pathological changes of hepatitis B cirrhosis. But the correlation between volume change and histological changes and functional changes, measurement of liver volume to be As a quantitative index for the diagnosis of liver cirrhosis severity, is reported in the literature in this area is less, and the design is not synchronized with the histopathological classification. Comparing the contents of this study was to explore the histological grade CT measurement of liver volume and liver pathology, clinical staging of liver cirrhosis, the relationship between Child-Pugh classification and MELD score, value.2 evaluation method for CT measurement of liver volume in liver cirrhosis and liver function in quantitative diagnosis from January 2012 to June 2014 hospitalized in the South Hospital of Southern Medical University, and in the hospital received liver biopsy after hepatitis B cirrhosis cases. Through the inclusion and exclusion criteria were obtained in this study were in 30 cases. The clinical data including albumin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, international standard Ratio, platelet count, serum creatinine. Preoperative gastroscopy within 1 week to determine whether esophageal varices, ascites underwent abdominal ultrasound. Clear liver biopsy within 1 weeks before the three phase enhanced 64 slice spiral CT thin + scanning, the images were imported into Mimics10.01 software, three-dimensional reconstruction of the liver, and calculation of CT liver volume. At the same time, according to the patients with liver cirrhosis and portal hypertension standard stage. In the 48 hours before surgery, the patients were according to the Child-Pugh classification and MELD score Child-Pugh standard for evaluation and model for end-stage liver disease and standard for evaluation. After liver biopsy, according to the Laennec histological classification the standard of pathological grading. Analysis of the Laennec classification, Child-Pugh classification, clinical stage, whether there is any difference between the MELD score of group CT liver volume, and the grading / staging system and CT liver volume The correlation between the results of.3 CT liver volume and liver volume theory in 30 patients were compared, the former was less than the latter (P0.05) classification of pathological changes in liver volume and liver.CT, liver cirrhosis clinical stage and MELD score showed a significant negative correlation (P0.01), correlation coefficient (R) were -0.55. -0.78 and -0.52; no significant correlation with Child-Pugh classification (r=-0.34). The Laennec classification, clinical stage, Child-Pugh grade, MELD score between group CT liver volume, the differences between groups were significant (P0.05); there was no significant difference between Child-Pugh A and CT liver volume B group (P0.05) conclusion.4 measurement CT the liver volume in patients with liver cirrhosis after hepatitis B can be used as the severity of liver cirrhosis and functional status of a quantitative diagnosis and evaluation index.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2;R512.62

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