肝脏淀粉样变性与肝窦阻塞综合征的临床和影像学的鉴别  

Clinical and imaging manifestation differential points between hepatic amyloidosis and hepatic sinus obstruction syndrome

作　　者：贾翠宇[1] 赵大伟[1] 王欣欣[1] 冯冀良 李瑞利[1] JIA Cuiyu;ZHAO Dawei;WANG Xinxin;FENG Jiliang;LI Ruili(Department of Radiology,Beijing You'An Hospital Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院放射科,北京100069

出　　处：《医学影像学杂志》2022年第10期1739-1744,共6页Journal of Medical Imaging

摘　　要：目的探讨肝淀粉样变与肝窦阻塞综合征(SOS)的临床和影像学鉴别点。方法选取病理诊断的7例肝淀粉样变性和15例肝窦阻塞综合征,并对两组患者的临床症状、实验室检查和影像表现进行统计学分析来确定鉴别点。结果两组患者的年龄、性别构成和临床症状无统计学差异。实验室检查:1)两组患者在甲胎蛋白、异常凝血酶原、CA-199、CEA间无统计学差异;2)淀粉样变患者的血小板升高率(85.7%对6.7%,P<0.001)和蛋白尿发生率(42.9%对0%,P=0.02)高于SOS,差异有统计学意义;3)总胆红素升高率(42.9%对100%,P<0.001)和凝血酶原时间异常率(57.1%对100%,P=0.02)低于SOS,差异有统计学意义。肝淀粉样变与SOS间差异有统计学意义的影像表现包括:脾脏增大(14.3%对80%,P=0.01)、侧支循环(0%对46.7%,P=0.04)、肝静脉狭窄或栓子(0%对80%,P<0.001)、三叶草或爪状强化(0%对46.7%,P=0.04),皆P<0.05。结论肝淀粉样变与肝窦阻塞综合征的实验室检查及影像表现存在一定的差异性,鉴别应两者相结合做出准确的诊断。Objective To investigate the clinical and imaging manifestations differential points between hepatic amyloidosis and hepatic sinus obstruction syndrome(SOS).Methods We retrospectively studied pathologically diagnosed 7 hepatic amyloidosis and 15 hepatic sinus obstructions.The clinical symptoms,laboratory examination and imaging findings of the two groups of patients were statistically analyzed to determine the differential points.Results There were no statistically significant differences in age and gender composition and clinical symptoms between the two groups.Laboratory tests:1)there was no statistically significant difference between the two groups in AFP,PIVKA,CA-199,CEA;2)patients with amyloidosis had higher rates of elevated platelets rate(85.7%vs 6.7%,P<0.001)and proteinuria rate(42.9%vs 0%,P=0.02)than SOS;3)and total bilirubin elevation rate(14.3%vs 80%,P<0.001)and abnormal rate of prothrombin time(57.1%vs 100%,P=0.02)were lower than SOS.The imaging findings with statistical differences between hepatic amyloidosis and SOS included enlarged spleen(14.3%vs 80%,P=0.01),collateral circulation(0%vs 46.7%,P=0.04),hepatic venous stenosis or embolus(0%vs 80%,P<0.001),clover-like sign or claw-like enhancement(0%vs 46.7%,P=0.04).Conclusion There are some differences between the laboratory examination and imaging findings of hepatic amyloidosis and hepatic sinusoidal obstruction syndrome,so they should be combined to make an accurate diagnosis.

关 键 词：肝淀粉样变 肝窦阻塞综合征 体层摄影术 X线计算机 磁共振成像 

分 类 号：R657.3[医药卫生—外科学] R814.42[医药卫生—临床医学] R445.2