慢性病毒性肝炎的CT征象与病情严重程度和预后评估的相关性研究

Relationship of CT manifestation of chronic viral hepatitis with severity of illness

目的探讨慢性乙型肝炎CT征象与肝炎严重程度的相关性,以及对其预后判定的应用价值。方法收集2009年1月~2012年12月在该院治疗的慢性乙型肝炎137例,所有患者均予以螺旋CT增强扫描,对肝脏及周边组织胆囊、脾、淋巴结异常改变进行观测,并对实验室相关指标进行检查,对慢性乙型肝炎CT征象以及实验室指标与肝炎严重程度作相关性分析,并对所有患者治疗情况进行随访统计分析。结果随慢性乙肝严重程度的加重,血清ALB水平降低,而血清ALT水平增高,两者在慢性乙型肝炎严重程度分级中的差异具有显著性（P〈0.05）;随慢性乙肝严重程度的加重,各种CT征像出现率增加,各CT征像在肝炎严重程度分级中的出现率差异具有显著性（P〈0.01）。血清ALB水平与CT征像存在负相关（P〈0.01）,血清ALT水平与CT征像存在正相关（P〈0.01）。患者治疗有效率随乙型肝炎病情严重程度的加重而逐渐下降（χ2=23.61,P〈0.01）。结论肝脏CT的晕环征,腹腔淋巴结肿大,胆道改变,腹腔积液和继发胸部改变等征象一定程度上能够反映慢性乙型肝炎的严重程度。螺旋CT检查对于评价其预后具有重要应用价值。

[ Objective ] To study the relationship between CT imaging features and the severity of chronic viral hepatitis. [Methods] The clinical data and laboratory information of 137 chronic virus hepatitis patients were reviewed retrospectively. All patients underwent standardized contrast-enhanced spiral CT dual-phase scanning of the upper abdomen. The changes of the liver, bile duct, spleen, portal venous system, lymph nodes of the upper abdomen, peritoneal cavity and pleural cavity were examined and noted. Correlation analysis was applied for the relationship of CT imaging features and the severity indices of chronic virus hepatitis. Patients were followed-up and therapeutic efficacy was summed up after treatment. [ Results ] As the severity of chronic hepatitis increased, which was reflected as serum albumin level went down and the value of ALT went up, the incidences of the following manifestations were also intensified intrahepatic perivaseular luceney, edema of the gallbladder fossa, enlargement of abdominal lymph nodes, ascite and thoracic changes correlation between these CT manifestations and clincal severity of chronic viral hepatitis was of statistical significance. The effective rate appeared a descent tendency with the severity of hepatitis B. [ Conclusions ] A close correlation occurs between certain CT features of chronic hepatitis and the clinical severity of chronic viral hepatitis.