基于Couinaud分段乙肝肝硬化肝段体积定量变化规律与肝功能相关性的研究

The Correlation Between the Quantitative Variation of Hepatic Segment Volume and Liver Function in Hepatitis B-Related Cirrhotic Liver: Based on Couinaud Segments

目的通过256层iCT基于Couinaud分段探讨乙肝肝硬化各肝段(Ⅰ~Ⅷ段)体积定量变化规律。方法搜集本院行256层iCT肝脏增强扫描的受检者,其中经临床综合诊断为乙肝肝硬化患者52例(肝硬化组),健康对照者48名(对照组)。根据实验室检查指标,肝硬化组分别计算MELD评分,并分为M1组(MELD评分≤10分)、M2组(11分≤MELD评分≤20分)、M3组(MELD评分≥21分)。通过iCT肝脏分段软件(Liver Segmentation)及Couinaud分段标准,测量肝脏总体积,得到标准肝脏体积(SLV);并逐段勾划各肝段形态,得到Ⅰ~Ⅷ段体积。肝硬化组肝段体积与MELD评分的相关性采用Spearman相关分析;采用两独立样本t检验和方差分析不同MELD评分组间各肝段体积变化规律。结果肝硬化组SLV为(532.3±143.2)cm^3/m^2,与MELD评分分值之间呈负相关,相关系数R=-0.82(P<0.05),决定系数R2=0.67。与对照组比,Ⅰ段体积占全肝百分比增大,但在M1、M2组Ⅰ段体积增大,M3组Ⅰ段体积减小,呈相对性增大。Ⅱ段、Ⅲ段体积占全肝百分比逐渐增大,但Ⅱ段、Ⅲ段体积随MELD评分增加逐渐减小,呈相对性增大。Ⅳ段体积随MELD评分增加逐渐减小,但其体积百分比变化无统计学差异(P>0.05)。Ⅴ段、Ⅵ段体积及其占全肝百分比随MELD评分增加逐渐减小,但在M1组时变化均无统计学差异(P>0.05),M2与M3组体积减小有统计学差异(P<0.05)。Ⅶ段、Ⅷ段体积及其占全肝百分比随MELD评分增加逐渐减小,均有统计学差异(P<0.05)。结论乙肝肝硬化各肝段体积随MELD评分改变变化规律不同,呈不对称性萎缩;准确评估肝硬化各段体积定量变化规律对临床精确评估患者病情进展具有重要临床意义。

Objective To discuss the hepatic segment（Ⅰ-Ⅷ） volume quantitative variation of hepatitis B cirrhosis based on Couinaud segments with 256-slice iCT. Methods 52 patients who were comprehensively diagnosed with cirrhosis and 48 normal controls underwent enhanced CT with 256-slice iCT. According to the laboratory examination,cirrhosis group had the MELD score calculated,and divided into 3 groups,M1（ MELD score≤10）,M2（ 11≤MELD≤score20） and M3（ MELD score≥21）. Measuring the total liver volume by the specialized software（ Liver Segmentation）,and according to the Couinaud＇s segmentation criteria,dividing and measuring the volume of each segment Ⅰ-Ⅷ. Correlation between hepatic segment volume and MELD score was analyzed by the Spearman correlation analysis. Each hepatic segment volume variation regularity in different MELD score groups was analysed by using two independent samples t test and variance analysis. Results The standardized liver volume was（ 532. 3 ± 143. 2） cm^3/m^2 for cirrhosis group. There was negative correlation between SLV and MELD score,the correlation coefficients was-0. 82（ P〈0. 05） and the coefficient of determination was 0. 67. Compared with the control group,the volume of segmentⅠwas increased in M1、M2,after that it decreased,but the percentage was always increased. The volume of segment Ⅱ and Ⅲ was increased in Group and after that it decreased,but the percentage was always relatively increased. The volume of segment Ⅳ was decreased with the change of MELD score,but there was no significant difference in the percentage between the three groups. There were no significant differences in either the volume or the percentage of segmentⅤ、Ⅵ decrease in M1（ P〈0. 05）. The volume of segment Ⅶ、Ⅷ decrease had statistically significant difference with the change of MELD score（ P〈0. 05）. Conclusion Hepatitis Brelated cirrhosis has asymmetric atrophy,and the volume of each segment changes were different with the change of MELD score. To accurately assess the quantitative variation of each segment has important clinical significances helping in understanding the clinical disease progression accurately.