磁共振弥散加权成像对慢性乙型肝炎肝纤维化程度和炎症活动程度的判断价值分析

Analysis of judgment value of magnetic resonance diffusion weighted imaging on the degree of liver fibrosis and inflammation activity levels in patients with chronic hepatitis B virus

目的探讨磁共振弥散加权成像(MR-DWI)对慢性乙型肝炎肝纤维化程度和炎症活动程度的判断价值。方法选择我院自2014年1月至2016年1月我院收治的84例慢性乙型肝炎肝纤维化患者和30例未发生肝纤维化患者(对照组)为研究对象,选取同期在我院门诊体检的30例健康人为正常组。所有研究对象均经肝穿刺及病理学检查证实并接受腹部MRI平扫及DWI检查,比较各组间不同弥散敏感系数(b)值时的表观弥散系数(ADC)值的差异,分析ADC值和肝纤维化程度(分为S1、S2、S3和S4组)和肝炎活动程度(分为G1、G2、G3和G4组)之间的相关性。结果当b值为100s/mm^2、200s/mm^2和400s/mm^2时,不同肝纤维化程度组间ADC值差异均无统计学意义(均P>0.05);而当b值为600s/mm^2和800s/mm^2时,S3组和S4组ADC值明显低于其他各组,差异均有统计学意义(均P<0.05)。当b值为100s/mm^2和2000s/mm^2时,不同肝炎活动程度组间ADC值差异均无统计学意义(均P>0.05);而当b值为400s/mm^2、600s/mm^2和800s/mm^2时,G3组和G4组ADC值明显低于其他各组,差异均有统计学意义(均P<0.05)。相关性分析结果表明,当b值为600s/mm^2和800s/mm^2时,ADC值与肝纤维化程度呈现出明显的负相关(r值分别为-0.563和-0.624,均P<0.05);当b值为400s/mm^2、600s/mm^2和800s/mm^2时,ADC值与肝炎活动程度呈现出明显的负相关(r值分别为-0.486、-0.586和-0.675,均P<0.05)。结论磁共振弥散加权成像对于诊断慢性乙型肝炎患者肝纤维化程度具有极高的临床价值,当b值为800s/mm^2时临床价值最高,且ADC值与肝纤维化程度和炎症活动程度密切相关,是一种值得推广应用的诊疗方法。

Objective To discuss the judgment value of magnetic resonance diffusion weighted imaging（MR-DWI） on the de- gree of liver fibrosis and inflammation activity levels in patients with chronic hepatitis B virus. Methods A total of 84 patients with with chronic hepatitis B virus who merged liver fibrosis and 30 cases with chronic hepatitis B virus who didn＇ t merged liver fibrosis（ the control group） admitted at our hospital from January 2014 to January 2016 were selected,and 30 cases of healthy people were taken o- ver as normal group in our hospital outpatient medical in the same period. All subjects were undergone liver biopsy and pathological ex- amination and accept abdominal MRI scan and DWI examination. To compare the differences between groups of different dispersion sen- sitive coefficient （b） value and apparent diffusion coefficient （ADC） and analyze the correlation between ADC values and degree of liver fibrosis（ SI, $2, $3 and $4 group）and inflammation activity levels （G1, G2, G3 and G4 group）. Results There were no statistical significance about liver fibrosis and AI）C values （ all P 〉 O. 05 ） when b values were 100s/mm2, 200s/mm2 and 400s/mm2 ; while the ADC values of $3 and $4 group were obviously lower than that of other groups, differences were statistical significance （ all P 〈 0. 05） when b values were 600s/mm2 and 800s/mm2. There were no statistical significance about inflammation activity levels and ADC values （ all P 〉 0. 05 ）when b values were 100s/mm2 and 200s/mm2 ;while the ADC values of G3 and G4 group were obviously lower than that of other groups,differences were statistical significance（ all P 〈0. 05 ）when b values were 400s/mm2 ,600s/mm2 and 800s/mm2. Rele- vant analysis results showed the relationships were highly significant negative （r values were respectively -0. 563 and -0. 624, all P 〈 0. 05 ） between ADC values and liver fibrosis when b values were 600s/mm2 and 800s/mm2 ,and the relationships were also highly sig- nificant negative （r values were respectively -0. 486, -0. 586 and -0. 675, all P 〈 0.05 ） between ADC values and inflammation ac- tivity levels when b values were 400s/mm2, 600s/mm2 and 800s/mm2. Conclusion Magnetic resonance diffusion weighted imaging applied to the diagnosis of liver fibrosis in patients with chronic hepatitis b has high clinical value and the value is optimal when b val- ues were 800s/mm2. The ADC value is very much close to the liver fibrosis and inflammation activity levels and it is worth to promote in clinical.