肝硬化老年男性病人影像指标与乳腺发育症的相关性分析

Correlation analysis between the imaging indexes and gynecomastia in elderly male patients with liver cirrhosis

目的:探讨综合使用各类影像学手段建立老年男性肝硬化与乳腺发育症相关性的可行性。方法:选取肝硬化老年男性病人123例为研究对象,年龄均>60岁。确定病人Child-Pugh分级,根据是否乳腺发育分为乳腺发育症组(n=53)和无乳腺发育症组(n=70)。采用CT、MRI或BUS影像学资料估算病人乳腺体积(V_(乳腺))、体表面积(BSA)、标准化乳腺体积(R_(乳/表))、正常肝脏体积(V_(肝脏)),区域增长或容积测算技术测定病变肝脏体积(V_(病肝))、肝脏体积变化率(R_(肝)),涂氏肝硬化影像学分级评估肝脏图像。结果:乳腺发育症组病人中19例呈单侧增大,34例呈双侧增大,单侧和双侧乳腺增生病人的R_(乳/表)分级差异有统计学意义(P<0.01)。2组病人V_(乳腺)、R_(乳/表)、Child-Pugh分级、Child-Pugh评分和肝硬化CT分级差异均有统计学意义(P<0.01),而V_(病肝)、R_(肝)差异均无统计学意义(P>0.05)。根据Child-Pugh分级法将2组病人分别分为A、B、C级,其中乳腺发育症组病人V_(乳腺)、R_(乳/表)随肝功能分级的增加均有增加趋势(P<0.05~P<0.01),且与无乳腺发育组各对应分级比较差异均有统计学意义(P<0.01);2组病人病变肝脏的V_(病肝)、R_(肝)随肝功能分级增加均有减小趋势(P<0.01),但2组各相应肝功能分级间比较差异均无统计学意义(P>0.05)。乳腺发育症组病人的V_(乳腺)、R_(乳/表)与肝功能Child-Pugh分级、涂氏肝硬化CT分级均呈明显正相关关系(P<0.01),V_(病肝)、R_(肝)与肝功能分级、涂氏肝硬化CT分级均呈明显负相关关系(P<0.01)。结论:综合使用各类影像学手段测量肝硬化老年男性病人的乳腺体积增大情况,可以帮助推断和评估病人肝功能损害和肝脏萎缩程度。

Objective:To explore the feasibility of using various imaging methods to establish the correlation between the severity of cirrhosis and gynecomastia in elderly men.Methods:A total of 123 elderly male patients with liver cirrhosis aged>60 years were selected as the research object.The Child-Pugh grade of patients was determined.According to the breast development,the patients were divided into the breast development group(n=53)and non-breast development group(n=70).The CT,MRI or BUS imaging data were used to estimate the breast volume(V_(breast)),body surface area(BSA),normalized breast volume(R_(breast/surface))and normal liver volume(V_(liver)).The regional growth or volume measurement techniques were used to measure the volume of diseased liver(V_(liver disease))and rate of change of liver volume(R_(liver)),and the imaging grading of smear cirrhosis was used to evaluate the liver images.Results:There were 19 cases of unilateral enlargement and 34 cases of bilateral enlargement in the breast development group.The difference of the R_(breast/surface) grade between unilateral and bilateral breast hyperplasia patients was statistically significant(P<0.01).The differences of the V_(breast),R_(breast/surfac),Child-Pugh grade,Child-Pugh score and CT grade of liver cirrhosis between two groups were statistically significant(P<0.01),while the differences of the V_(disease liver) and R_(liver) were not statistically significant(P>0.05).According to the Child-Pugh grading method,the patients in the two groups were divided into the A,B and C grades,respectively.The V_(breast) and R_(breast/surface) of patients in the breast development group showed an increasing trend with the increase of liver function grade(P<0.05 to P<0.01),and the differences of which was statistically significant compared with those in the non-breast development group(P<0.01).The V_(disease liver) and R_(liver) of the diseased liver in two groups showed a decreasing trend with the increase of liver function grade(P<0.01),but there was no statistical significance in the corresponding liver function grade between two groups(P>0.05).There were significant positive correlations among the V_(breast),R_(breast/surface),Child-Pugh grade of liver function and CT grade of smear cirrhosis(P<0.01),while there were significant negative correlations among the V_(disease liver) and R_(liver) and liver function grade and CT grade of smear cirrhosis(P<0.01).Conclusions:The comprehensive use of various imaging methods to measure the enlargement of breast volume in elderly male patients with cirrhosis can help to infer and evaluate the degree of liver function damage and liver atrophy.