原发性胆汁性胆管炎超声表现及与实验室指标的相关性研究

Correlation of ultrasonic manifestation and laboratory indexes in patients with primary biliary cholangitis

目的探讨原发性胆汁性胆管炎(primary biliary cholangitis,PBC)的超声表现,分析不同病理分期的生化、免疫指标的差异。方法回顾性分析病理确诊的75例PBC患者的超声表现、病理资料及临床实验室检查结果,总结不同病理分期超声表现,分析PBC患者的病理分期与肝功能、免疫学指标的相关性。结果不同病理分期的PBC患者超声表现不同:Ⅰ期患者超声表现正常或回声稍增粗,Ⅱ期患者超声表现为回声增粗及呈条索样改变,Ⅲ、Ⅳ期患者超声表现多呈条索及结节样改变,且部分患者可出现门静脉周围的低回声区。对实验室检查与纤维化病理分期的分析显示,ALT、ALP水平在4期之间差异有统计学意义(P均<0.05),两两比较发现Ⅲ期ALT、ALP水平大于Ⅰ、Ⅱ期,其余各期之间差异无统计学意义(P均>0.05);Ig G水平在4期患者之间差异有统计学意义(P<0.05),两两比较发现Ⅳ期水平大于Ⅰ期,其余各期之间差异无统计学意义(P均>0.05)。结论超声在PBC各病理分期的特征性影像学改变结合生化免疫指标,可对PBC提供客观的无创诊断依据,并与PBC的病理纤维化程度具有相关性。

Objective To observe ultrasonic manifestation in patients with primary biliary cholangitis(PBC)and analyze the differences of biochemical and immune indexes at different pathological stages.Methods Ultrasonic manifestation,pathological data and clinical laboratory findings of 75 patients with pathologically diagnosed PBC were retrospectively analyzed to summarize ultrasonic manifestation at different pathological stages,and to analyze the correlation of pathological staging with liver function and immunological indexes in PBC patients.Results PBC patients exhibited different ultrasonic manifestations at different pathological stages.Normal ultrasound and slightly thickening echoes were shown at stage I.Echo thickening and stripe-like changes were found at stage II.Stripe and nodular changes were dominant at stage III andⅣ.Hypoechoic regions around the portal vein appeared in some patients.Statistical analysis of laboratory examination and pathological staging of fibrosis showed that ALT and ALP levels showed statistically significant difference among 4 stages(P<0.05),levels of ALT,ALP at stage III were higher than those at stages I and II,while the differences among other stages were not statistically significant(P>0.05);the differences of lgG level among 4 stages were statistically significant(P<0.05),lgG level at stageⅣwas higher than that at stage I,while the differences among other stages were not statistically significant(P>0.05).Conclusions The characteristic ultrasonic imaging changes at each pathological stage of PBC,in combination with biochemical immunity indexes,will provide objective basis for noninvasive diagnosis of PBS,which are correlated with the severity of pathological fibrosis of PBC.