肝硬化的CT评价指标及其与血清纤维化标志物的相关性

CT evaluation indexes of liver cirrhosis and the correlation with serum fibrosis markers

目的探讨肝硬化患者的CT评价指标及与血清纤维化标志物的相关性。方法收集50例肝硬化患者,根据肝功能情况分为Child A组、Child B组及Child C组。以25名肝脏正常的其他疾病患者或健康体检者为正常对照组。对所有研究对象均行CT扫描,比较肝硬化各组与正常对照组之间及肝硬化各组之间肝脏各叶径线、门静脉内径及脾脏体积的差异。对肝硬化患者进行血清学检查,包括Ⅳ型胶原(Ⅳ-C)和层黏连蛋白(LN)。分析肝硬化患者肝右叶冠状径与肝左叶冠状径的比值(R1/L1)、门静脉内径及脾脏体积与血清Ⅳ-C及LN水平的相关性。结果与正常对照组相比,肝硬化各组肝左叶冠状径(L1)均增大(P<0.01),肝右叶冠状径(R1)、矢状径(R2)及R1/L1比值均减小(P<0.05),且肝硬化各组间R1、R2及R1/L1比值的差异有统计学意义(P<0.05)。肝硬化各组门静脉内径及脾脏体积均较正常对照组增大(P<0.01),但肝硬化各组间门静脉内径及脾脏体积的差异无统计学意义(P>0.05)。肝硬化患者R1/L1比值与血清Ⅳ-C及LN均呈负相关(r值分别为-0.420、-0.575,P均<0.01),门静脉内径与LN呈正相关(r=0.407,P<0.01)。结论 R1/L1比值能较为可靠地反映肝硬化的程度及肝纤维化的进展。

Objective To investigate CT evaluation indexes and the correlation between CT indexes and serum fibrosis markers in patients with liver cirrhosis.Methods Totally 50 patients of liver cirrhosis were divided into 3 groups according to Child-Pugh Classification of liver function,namely Child A group,Child B group and Child C group.And 25 subjects with normal liver were enrolled in the control group.Spiral CT scan were performed in all subjects.Then the diameters and the ratios of hepatic lobe,the diameter of portal vein and the volume of spleen among Child A,B,C groups and control group as well as among Child A,B and C groups were compared.In addition,all patients underwent serologic examination,serum fibrosis markers including collagen type Ⅳ（Ⅳ-C） and laminin（LN） were checked.The correlation between the ratio of coronal diameters in right and left lobes of the liver（R1/L1）,the portal vein diameter,the splenic volume and the serological indexes was analyzed.Results Compared with control group,the coronal diameter in left lobe of the liver（L1） increased（P〈0.01）,while the coronal diameter（R1）,the sagittal diameter（R2） in right lobe of the liver and R1/L1 decreased（P〈0.05）.Statistical differences of R1,R2 and R1/L1 were found among Child A,B and C groups（P〈0.05）.The portal vein diameter and the splenic volume in Child A,B and C groups were significantly higher than those in control group（P〈0.01）,but there was no significant difference among Child A,B and C groups（P〉0.05）.R1/L1 was negatively correlated to Ⅳ-C and LN in liver cirrhosis patients（r=-0.420,-0.575,all P〈0.01）.There was positive relationship between portal vein diameter and LN（r=0.407,P〈0.01）.Conclusion R1/L1 can be reliably used to reflect the severity of liver cirrhosis and the progress of liver fibrosis.