CT肝细胞外基质体积分数评估慢性丙型肝炎患者持续病毒学应答前后的肝纤维化变化  

Evaluation of liver fibrosis changes in patients with chronic hepatitis C before and after continuous virological response by CT extracellular matrix volume fraction

作　　者：梁占东[1] 刘燕霞 谢晋 邹殿俊[1] 刘兰 崔书君[1] LIANG Zhan-dong;LIU Yan-xia;XIE Jin;ZOU Dian-jun;LIU Lan;CUI Shu-jun(Department of Medical Imaging,The First Affiliated Hospital of Hebei North University,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院医学影像部,河北张家口075000 [2]张家口市传染病医院超声科,河北张家口075000

出　　处：《影像诊断与介入放射学》2023年第2期103-109,共7页Diagnostic Imaging & Interventional Radiology

基　　金：张家口市科学技术研究与发展计划项目(1911021D-5)。

摘　　要：目的分析慢性丙型肝炎患者获得持续病毒学应答(SVR)后肝细胞外基质体积分数(HECV)与肝纤维化变化的关系。方法收集慢性丙型肝炎经抗病毒药物初治患者94例,均完成基线腹部CT多期增强检查及肝脏穿刺检查,且在SVR后进行规律随访并完成肝脏穿刺及腹部CT多期增强检查。通过平扫及延迟期(注射对比剂180 s后)计算肝实质及主动脉绝对强化值,并根据公式计算HECV。根据治疗前后Metavir评分变化分为3组:逆转组(Metavir评分下降≥1)、稳定组(Metavir评分无变化)、进展组(Metavir评分升高≥1)。多组间比较采用单因素方差分析或Kruskal-wallis H检验;治疗前与SVR后肝脏HECV值比较采用Wilcoxon配对秩和检验。并采用独立ROC曲线下面积对比Z检验分析HECV在治疗前与获得SVR后诊断预测进展期肝纤维化/肝硬化的差异。结果本研究中慢性丙型肝炎患者经治疗获得SVR后,8例(8.50%)被判断为纤维化逆转,71例(75.53%)为稳定,15例(15.97%)为进展。逆转组治疗前HECV为27.50(27.00~35.38),在获得SVR后HECV为24.90(23.58~28.05),较治疗前有所下降,而进展组患者在获得SVR后的HECV值[39.70(32.60~40.90)]要明显高于治疗前[34.60(28.20~37.20)](P<0.05)。稳定组中,患者治疗前HECV值[36.20(34.50~38.90)]与获得SVR后的HECV值[36.50(34.80~39.10)]无明显变化。慢性丙型肝炎患者获得SVR后HECV值诊断预测进展期肝纤维化的AUC[0.761(95%CI:0.664~0.858)]与治疗前AUC[0.711(95%CI:0.606~0.816)]差异无统计学意义(Z=-0.686,P>0.05)。获得SVR后HECV值诊断预测肝硬化的AUC[0.940(95%CI:0.877~1.000)]与治疗前AUC[0.930(95%CI:0.874~0.986)]差异无统计学意义(Z=0.232,P>0.05)。结论慢性丙型肝炎患者获得持续性病毒应答后,肝细胞外基质体积分数的变化随肝纤维程度发生同向变化。Objective To investigate the association between the hepatic extracellular volume fraction(HECV)and the reversal outcome of liver fibrosis in patients with chronic hepatitis C after sustained virological response(SVR).Methods 94 patients with chronic hepatitis C initially treated with antiviral drugs were collected.All patients were performed baseline abdominal CT enhancement and liver biopsy,and they were followed up regularly after SVR and underwent abdominal CT enhancement and liver biopsy.Absolute enhancements(in Hounsfield unit)of the liver parenchyma and aorta 180 seconds after contrast administration were calculated using precontrast and equilibrium phase scans.According to the change in Metavir score after treatment,the patients were divided into regression group(a reduction≥1 in Metavir score),stabilization group(no change in Metavir score),and progression group(an increase≥1 in Metavir score).Oneway ANOVA or Kruskal Wallis H test was used for comparison among groups.Wilcoxon paired rank sum test was used to compare HECV before treatment and after SVR.The area comparison Z test under the independent ROC curve was used to analyze the difference between the diagnosis and prediction of advanced liver fibrosis and cirrhosis by HECV before treatment and after SVR.Results In the patients with chronic hepatitis C and combined with SVR after treatment,8 cases(8.50%)achieved the histological outcome of definite regression of liver fibrosis,71 cases(75.53%)achieved the histological outcome of stabilization,and 15 cases(15.97%)experienced progression.In the regression group,the HECV after obtaining SVR[24.90(23.58-28.05)]was significantly lower than the HECV before treatment[27.50(27.00-35.38)].The HECV after obtaining SVR in the progression group[39.70(32.60-40.90)]was significantly higher than that before treatment[34.60(28.20-37.20)](P<0.05).In the stable group,there was no significant difference for the HECV value between pre-treatment[36.20(34.50-38.90)]and that after SVR[36.50(34.80-39.10)].There was no s

关 键 词：慢性丙型肝炎 肝纤维化 肝细胞外基质 持续病毒学应答 体层摄影术 X线计算机 

分 类 号：R512.63[医药卫生—内科学] R575.2[医药卫生—临床医学] R814.42