普美显增强CE-MRC对肝硬化患者肝功能评价的应用价值  

The Application Value of GD-EOP-GTPA Enhanced CE-MRC in Liver Function Evaluation of Patients with Cirrhotic

作　　者：李亮杰[1] 贾啟龙 刘志飞[1] 谭新华[1] 邹科 LI Liangjie;JIA Qilong;LIU Zhifei;TAN Xinhua;ZOU Ke(Kashgar First People’s Hospital,Kashgar 844000,China)

机构地区：[1]新疆喀什地区第一人民医院,新疆喀什844000

出　　处：《中国医学创新》2020年第16期22-26,共5页Medical Innovation of China

基　　金：新疆自治区卫计委青年医学科技人才专项资金资助项目(WJWY-201838)。

摘　　要：目的:分析肝硬化患者普美显(钆塞酸二钠)增强扫描不同时相的胆管显示情况与临床实验室检查指标及临床Child-Pugh分级的相关性和一致性,来拓展影像学在评估术前肝硬化肝癌患者肝功能方面的应用.方法:收集具有临床肝功能Child-Pugh分级的肝硬化患者71例.所有患者均行MRI平扫、注射普美显后行动态增强扫描及20 min肝胆期扫描、60 min排泄期扫描.根据肝胆期和排泄期的胆道评分情况,对71例患者的肝胆管显示情况进行MRI分级,探讨不同时期肝功能MR胆管分级与临床肝功能Child-Pugh分级的一致性及相关性;同时探讨与肝功能分级密切相关的指标血清总胆红素、人血白蛋白、血浆凝血酶原时间对肝胆期胆管显示的影响情况.结果:肝胆期MRI胆管分级与临床Child-Pugh分级一致性较好(K=0.849),也具有高度正相关性(r=0.897).排泄期MRI胆管分级与临床Child-Pugh分级一致性尚可(K=0.458),相关性为中度正相关(r=0.569).肝胆期胆管显示情况与血清总胆红素及血浆凝血酶原时间呈中度负相关(r=-0.720、-0.650),与人血白蛋白呈中度正相关(r=0.630),排泄期胆管显示情况与血清总胆红素及血浆凝血酶原时间呈中、低度负相关(r=-0.540、-0.430),与人血白蛋白无相关性(r=0.280).结论:对肝硬化患者进行GD-EOB-DTPA增强扫描CE-MRC通过对各级胆管显示情况的分析可以间接评估患者的肝功能情况,对术前肝硬化肝癌患者是否能够耐受手术和耐受何种程度的手术具有重要的意义.Objective:To analyze the correlation and consistency between the clinical laboratory examination indexes and the clinical Child-Pugh grade in the bile duct display of different phases in the enhanced scan of GD-EOB-DTPA in patients with cirrhosis,so as to expand the application of imaging in the evaluation of liver function in patients with preoperative cirrhosis of liver cancer.Method:The total of 71 cases of cirrhosis with Child-Pugh grade of clinical liver function were collected.All patients underwent MRI plain scan,dynamic enhancement scan,20 min hepatobiliary scan,and 60 min excretory scan after injection of GD-EOB-GTPA.According to the biliary tract score of the evaluation of hepatobiliary stage and excretion stage,the cutoff value of medical reference was obtained,and the hepatobiliary duct display of 71 patients was graded by MRI.The consistency and correlation between MR bile duct grading of liver function and Child-Pugh grading of clinical liver function in different periods were investigated.The effect of serum total bilirubin,serum albumin and plasma prothrombin time on the cholangiopancreatography were also discussed.Result:There was better consistency between the bile duct in hepatobiliary phase MRI and clinical Child-Pugh classification(K=0.849),the correlation was high positive correlation(r=0.897).There was good consistency between the grade of bile duct in excretory MRI and clinical Child-Pugh grade(K=0.849),the correlation was moderate positive(r=0.569).There was a moderate negative correlation between the display of bile duct and serum total bilirubin and plasma prothrombin time(r=-0.720,-0.650),a moderate positive correlation with serum albumin(r=0.630).There was a moderate negative correlation between the display of bile duct and serum total bilirubin and plasma prothrombin time(r=-0.540,0.430),but no correlation with serum albumin(r=0.280).Conclusion:GD-EOB-DTPA enhanced scanning CE-MRC can indirectly evaluate the liver function of patients with liver cirrhosis by analyzing the bile duct d

关 键 词：普美显 CE-MRC 肝硬化 肝功能 

分 类 号：R575.2[医药卫生—消化系统] R445.2[医药卫生—内科学]