磁共振成像与乙肝后肝硬化中医证型的相关性研究

Correlation Study between Magnetic Resonance Imaging and TCM Syndrome Types of Post-hepatitis B Cirrhosis

目的:探究乙肝后肝硬化患者肝脏磁共振成像MRI形态学及功能性改变与中医证型的相关性,以期为肝硬化患者中医证候分型及临床辨证治疗提供客观依据。方法:对纳入的164例符合乙肝后肝硬化诊断的患者在进行标准化中医辨证分型后,行MRI常规序列及弥散加权成像(DWI)检查,分析6种乙肝后肝硬化证型的肝左叶、右叶、尾状叶、肝脏长径、左右叶比例失常等形态学改变,并探究DWI功能性成像对证候分型的价值。结果:肝气郁结型右叶横径、矢状径、肝脏长径与其他5型比较,差异均有统计学意义(P<0.05)。肝气郁结型肝左叶横径与脾肾阳虚型、肝肾阴虚型比较,差异有统计学意义(P<0.05)。除肝肾阴虚型肝左叶矢状径与肝气郁结型、湿热蕴结型、瘀血阻络型比较和水湿内阻型肝尾状叶横径与瘀血阻络型比较,差异有统计学意义外(P<0.05),其他各型尾状叶横径、矢状径、左叶矢状径值比较,差异均无统计学意义(P>0.05)。肝左右叶横径之比、矢状径之比与肝硬化证型进展呈较强的正相关(r=0.45、0.40,P<0.05),且相比于单个形态学数值对证候辨证分型具有较高的价值。ADC值与肝硬化证型进展呈显著负相关(r=0.81),而且除瘀血阻络型肝脏ADC值与湿热蕴结型及瘀血阻络型与水湿内阻型比较,差异无统计学意义外(P>0.05),其余各型ADC值比较,差异均有统计学意义(P<0.05)。结论:MRI形态学表现和弥散加权功能成像乙肝后肝硬化证候分型有一定的相关性,能为肝硬化中医证候分型提供的诊断价值。

Objective:To investigate the correlation between liver magnetic resonance imaging(MR)morphological as well as functional changes and TCM syndrome types in patients with post-hepatitic B cirrhosis,in order to provide scientific basis for TCM syndrome differentiation and clinical treatment in patients with hepatic cirrhosis.Methods:A total of 164 patients with post-hepatitic B cirrhosis were diagnosed through standardized TCM syndrome differentiation,then MR conventional sequence and diffusion weighted imaging(DWI)were performed.The diameter of left lobe,right lobe,caudate lobe,hepatic vertical length and the proportion of left and right hepatic lobe disorders were analyzed among 6 TCM syndrome types of post-hepatitic B cirrhosis;DWI parameters were measured to evaluate its value for different TCM syndrome types.Results:Diameter of hepatic right lobe transverse,sagittal and hepatic vertical length of liver qi depression were significantly smaller compared with other 5 TCM syndrome types of post-hepatitic B cirrhosis(P<0.05).In comparasion with spleen-kidney yang deficiency and liver-kidney yin deficiency,liver qi depression has significant smaller hepatic right lobe transverse diameter(P<0.05).There were no significant difference in caudate lobe sagittal diameter,transverse diameter and left lobe sagittal diameter among any other TCM syndrome types of post-hepatitic B cirrhosis(P>0.05),except significant difference of caudate lobe transverse diameter between internal water-damp obstructin and static blood obstructing collaterals(P<0.05)as well as significant difference of caudate lobe transverse diameter between liver-kidney yin deficiency and three TCM syndrome types(liver qi depression,damp-heat accumulation and static blood obstructing collaterals)(P<0.05).There were strong positive correlation between the ratio of transverse and sagittal diameter of liver left/right and progress of TCM syndromes(r=0.45,0.40,respectively,P<0.05),and theses ratio values perform better compared to single diameter.ADC value was decreasing with the progress of syndromes(r=-0.81),and perform better in different syndromes types(P<0.05),although there were no significant difference between static blood obstructing collateral and two types(damp-heat accumulation and internal water-damp obstruction)(P>0.05).Conclusion:MR morphological and diffusion weighted imaging characteristics are associated with TCM syndrome types of post-hepatitis B cirrhosis,which can provide high diagnostic value for TCM syndromes differentiation.