HBV感染患者的肝脾体积测量在评估肝纤维化程度中的应用  

Application of liver and spleen volume measurement in assessing the degree of liver fibrosis in patients with HBV infection

作　　者：宋春瑶[1] 王子荣[1] 唐栋[1] SONG Chun-yao;WANG Zi-rong;TANG Dong(Department of Radiology,Affiliated Hospital of Hangzhou Normal University,Hangzhou,Zhejiang 310015,China)

机构地区：[1]杭州师范大学附属医院放射科,浙江杭州310015

出　　处：《中华全科医学》2020年第4期630-633,共4页Chinese Journal of General Practice

基　　金：浙江省医学会临床科研项目(2016ZYC-A40)。

摘　　要：目的评价乙型肝炎病毒感染(HBV)患者的肝脾体积测量在评估肝硬化程度中的应用价值。方法收集2015年2月-2018年8月于杭州师范大学附属医院进行诊治的肝硬化的HBV感染患者(110例),选择同期诊治的健康成年人作为对照组(42例)。分别行螺旋CT扫描,测量其肝脏各叶及脾脏体积,计算各叶所占全肝比例及肝脾比值,与肝穿刺病理结果对照。结果肝左外叶体积、尾叶体积及体积比值在对照组中最小,随着肝纤维化进展逐渐增大,其中肝硬化组肝左外叶体积最大(均P<0.05)。肝右叶、肝方叶及总肝体积随肝纤维化进展,在S2期最大,随后呈下降趋势,肝硬化组体积最小(均P<0.05)。脾脏体积随肝纤维化进展,呈持续增加趋势,以肝硬化亚组体积最大;肝脾比值随肝纤维化进展,呈持续下降趋势,以肝硬化组最小(均P<0.05)。左外叶/总肝、尾叶/总肝比值与肝纤维化呈高度正相关(均P<0.05);总肝/脾脏比值与左外叶/总肝、肝纤维化呈高度负相关(均P<0.05)。结论螺旋CT测量肝及脾的体积是评估乙肝后肝硬化程度的一个无创的可靠手段,随着肝纤维化进展,肝脾体积与之存在不同程度相关性,其中肝左外叶、尾叶、脾脏体积与纤维化的相关性较高。Objective To evaluate the value of liver spleen volume measurement in assessing the degree of liver fibrosis in patients with hepatitis B virus(HBV) infection. Methods Total 110 HBV-infected patients with cirrhosis diagnosed at the Hangzhou Normal University Affiliated Hospital from February 2015 to August 2018 were enrolled. The 42 healthy adults treated in our hospital were selected as the control group. Spiral CT scans were performed to measure the volume of each hepatic lobe and the volume of spleen. The ratio of each hepatic lobe volume/total liver volume and the ratio of total liver volume/spleen volume were calculated and compared with the pathological results. Results The volume of the left lateral lobe, the volume of the caudate lobe and their ratio to the whole liver volume were the smallest in the control group, and increased gradually with the progress of liver fibrosis, and the volume of the left lateral lobe was the largest in the cirrhosis group(all P<0.05). The right lobe, quadrate lobe and total liver volume were the largest in stage S2 and then decreased with the progress of liver fibrosis, and the smallest in cirrhosis group(all P<0.05). The volume of spleen increased continuously with the progress of liver fibrosis, and its volume was the largest in the subgroup of cirrhosis. The value of whole liver volume/spleen volume decreased continuously with the progress of liver fibrosis, and was the smallest in the cirrhosis group(all P<0.05). The values of left lateral lobe volume/total liver volume, tail lobe volume/total liver volume were positively correlated with liver fibrosis(all P<0.05), while the values of total liver volume/spleen volume were negatively correlated with left lateral lobe volume/total liver volume, and liver fibrosis(all P<0.05). Conclusion Measuring the volume of liver and spleen by spiral CT is a non-invasive and reliable method to evaluate the degree of liver cirrhosis after HBV infection. With the progress of liver fibrosis, the volume of liver and spleen has different deg

关 键 词：螺旋CT 肝脏 脾脏 体积测量 肝硬化 

分 类 号：R512.62[医药卫生—内科学] R445.3[医药卫生—临床医学]