定量磁共振成像诊断原发性胆汁性肝硬化患者门静脉高压症价值分析

Clinical value of quantitative magnetic resonance imaging in the diagnosis of portal hypertension in patients with primary biliary cirrhosis

目的探讨应用定量MRI和血清学指标诊断原发性胆汁性肝硬化(PBC)患者门静脉高压症的价值。方法2010年1月~2018年12月我院收治的PBC患者45例,获得并计算天门冬氨酸氨基转移酶/血小板比值指数(APRI)和纤维化指数-4(FIB-4)评分,行腹部磁共振成像检查,提取肝脾硬度、T1、T2和表观弥散系数(ADC)值,绘制受试者工作特征曲线下面积(AUC),分析各指标诊断门静脉高压症的效能。结果在45例PBC患者中,发现14例(31.1%)存在门静脉高压症;14例门静脉高压症患者APRI评分为2.21(1.82,2.74)分,FIB-4评分为1.65(1.02,1.94)分,肝脏硬度为4.87(4.15,5.46)kPa,脾脏硬度为9.75(7.54,11.77)kPa,肝脏T1为1024.8(975.4,1078.5)ms,肝脏T2为62.7(57.4,68.4)ms,ADC值为1.29(1.11,1.62)×10^-3 mm^2/s,显著高于31例无门静脉高压症患者[分别为0.68(0.21,0.94)分、0.24(0.18,0.42)分、2.51(2.11,2.98)kPa、5.23(4.62,6.08)kPa、930.8(870.9,980.4)ms、56.8(55.3,58.7)ms和1.08(1.02,1.25)×10^-3 mm^2/s,P<0.05];APRI、FIB-4、MR检测肝硬度和脾硬度诊断门脉高压的灵敏度分别为90.4%、82.3%、92.4%和90.3%,特异度分别为79.6%、91.2%、92.0%和93.2%。结论采用MRI检测肝脾硬度联合APRI和FIB-4评分可以帮助诊断PBC患者门静脉高压症,值得临床进一步验证。

Objective The aim of this study was to investigate the clinical value of quantitative MRI and serological indexes in the diagnosis of portal hypertension(PH)in patients with primary biliary cirrhosis(PBC).Methods Forty-five patients with PBC were admitted to our hospital from January 2010 through December 2018.The aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4(FIB-4)were obtained.All patients with PBC underwent MRI examination.The receiver-operating characteristic curve(ROC curve)was drawn to analyze the diagnostic value of quantitative MRI index,APRI and FIB-4 for portal hypertension diagnosis.Results 14(31.1%)patients with PBC in our series had PH;in the 14 patients with PH,the APRI score was 2.21(1.82,2.74),FIB-4 score was 1.65(1.02,1.94),liver stiffness was 4.87(4.15,5.46)kPa,spleen stiffness was 9.75(7.54,11.77)kPa,T1 of liver was 1024.8(975.4,1078.5)ms,T2 of liver was 62.7(57.4,68.4)ms,and ADC was 1.29(1.11,1.62)×10^-3 mm^2/s,significantly higher than 0.68(0.21,0.94),0.24(0.18,0.42),2.51(2.11,2.98)kPa,5.23(4.62,6.08)kPa,930.8(870.9,980.4)ms,56.8(55.3,58.7)ms and 1.08(1.02,1.25)×10^-3 mm^2/s in 31 patients without PH(P<0.05);the sensitivity by APRI,FIB-4,liver and spleen stiffness by MR determination in diagnosing PH were 90.4%,82.3%,92.4%and 90.3%,and the specificity were 79.6%,91.2%,92.0%and 93.2%,respectively.Conclusion The serological indexes and liver and spleen stiffness determined by MRI might help judge the existence of portal hypertension in patients with PBC,which needs further investigation.