螺旋CT测定肝脏体积评估乙型肝炎肝硬化患者肝脏储备功能的应用

目的 运用螺旋CT扫描测定肝脏体积评估乙型肝炎肝硬化患者肝脏储备功能。方法 2016年6月～2020年2月我院诊治的乙型肝炎肝硬化患者60例,行CT增强扫描,应用法国Intrasense公司的Myrian XP Liver医学图像分析软件计算实际肝脏体积(PLV),并与理论肝脏体积(TLV)比较。根据肝脏CT表现,将肝硬化分为1～4级。结果 本组肝硬化CT分级为1级12例,2级25,3级13例和4级10例; CT 1级患者PLV为(996.2±145.5)cm³,显著小于TLV【(1440.2±106.2)cm³, P<0.05】,2级患者PLV为(918.2±116.4)cm³,显著小于TLV【(1408.8±92.0)cm³,P<0.05】,3级患者PLV为(852.4±70.8)cm³,显著小于TLV【(1380.2±104.8)cm³,P<0.05】,4级患者PLV为(724.9±92.3)cm³,也显著小于TLV【(1352.1±88.2)cm³,P<0.05】;15例Child-Pugh A级患者PLV为(985.2±250.8)cm³,显著小于TLV【(1420.6±125.0)cm³,P<0.05】,31例B级患者PLV为(820.6±105.4)cm³,显著小于TLV 【(1381.8±110.8)cm³,P<0.05】,14例C级患者PLV为(704.6±70.5)cm³,显著小于TLV 【(1340.5±120.9)cm³,P<0.05】;14例MELD评分＜10分患者PLV为(960.6±162.5)cm³,显著小于TLV【(1408.2±92.8)cm³,P<0.05】,28例MELD评分为10～20分患者PLV为(842.6±90.6)cm³,显著小于TLV【(1372.4±108.0)cm³,P<0.05】,18例MELD评分＞20分患者PLV为(782.1±40.8)cm³,显著小于TLV 【(1325.0±130.8)cm³,P<0.05】。结论 应用分析软件测定螺旋CT扫描获得的实际肝脏体积能够有效评价乙型肝炎肝硬化患者肝硬化程度及其储备功能,值得临床总结应用。

Evaluation of hepatic functional reserve using practical liver volumes measured by enhanced CT scan in patients with hepatitis B liver cirrhosis

Objective The aim of this study was to evaluate hepatic functional reserve using practical liver volumes (PLV) measured by enhanced CT scan in patients with hepatitis B liver cirrhosis (LC). Methods A total of 60 patients with hepatitis B LC underwent spiral CT examination in our hospital between June 2016 and February 2020. The PLV was calculated by Myrian XP Liver software and compared to theoretical liver volumes (TLV). The LC was divided into four class based on CT imaging. Results The LC in our series was found to be class 1 in 12, class 2 in 25, class 3 in 13 and class 4 in 10; the PLV in patients with class 1 was (996.2±145.5)cm³, significantly smaller than TLV 【(1440.2±106.2)cm³, P<0.05】, the PLV in patients with class 2 was (918.2±116.4)cm³, significantly smaller than TLV【(1408.8±92.0)cm³, P<0.05】, the PLV in class 3 was (852.4±70.8)cm³, much smaller than TLV【(1380.2±104.8)cm³, P<0.05】 and the PLV in patients with class 4 was (724.9±92.3)cm³, significantly smaller than TLV【(1352.1±88.2)cm³, P<0.05】; the PLV in 15 patients with Child-Pugh class Awas (985.2±250.8)cm³, significantly smaller than TLV【(1420.6±125.0)cm³, P<0.05】, the PLV in 31 patients with class B was (820.6±105.4)cm³, significantly smaller than TLV 【(1381.8±110.8)cm³, P<0.05】 and the PLV in 14 patients with Child-Pugh class C was (704.6±70.5)cm³, significantly smaller than TLV 【(1340.5±120.9)cm³, P<0.05】; the PLV in 14 patients with MELD score less than 10 was (960.6±162.5)cm³, much smaller than TLV【(1408.2±92.8)cm³, P<0.05】, the PLV in 28 patients with MELD score of 10 to 20 was (842.6±90.6)cm³, significantly smaller than TLV【(1372.4±108.0)cm³, P<0.05】, and the PLV in 18 patients with MELD score greater than 20 was (782.1±40.8)cm³, significantly smaller than TLV 【(1325.0±130.8)cm³, P<0.05】. Conclusion The actual liver volume measured by spiral CT scan might effectively evaluate the functional reservoir in patients with hepatitis B liver cirrhosis, which warrants further clinical investigation.