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乙肝肝硬化患者肝脏体积萎缩率及LSM、CTP值与Laennec组织病理学分级的关系
引用本文:刘钦成,刘宁,韩晓玉,郭凌宏,王春明,廖彩仙.乙肝肝硬化患者肝脏体积萎缩率及LSM、CTP值与Laennec组织病理学分级的关系[J].重庆医学,2018(14):1870-1873,1877.
作者姓名:刘钦成  刘宁  韩晓玉  郭凌宏  王春明  廖彩仙
作者单位:南方医科大学南方医院肝胆外科,广州,510515
基金项目:南方医科大学南方医院与恒丰实业集团有限公司合作科研项目
摘    要:目的 为探索乙型病毒性肝炎(以下简称乙肝)后肝硬化患者的肝脏体积(LV)萎缩率及肝脏弹性值(LSM)、Child-Turcotte-Pugh (CTP)评分值与Laennec肝硬化组织病理学分级的关系,以及其在肝硬化程度量化诊断中的价值.方法 回顾性分析32例乙肝后肝硬化患者的肝活检组织病理玻片、肝脏瞬时弹性成像(FS)和CT检查,以及血液学检验等临床和病理资料.并参照Laennec肝硬化组织病理学分级标准把肝硬化分为轻、中、重度.分析患者的LV萎缩率及LSM、CTP评分值与肝硬化程度组织病理学分级的相关关系.结果 32例患者中肝硬化组织病理学分级为轻度9例(28.12%),中度12例(37.50%),重度11例(34.38%).肝硬化程度轻、中、重3组患者的肝脏体积萎缩率分别为(16.75±2.20)%、(23.11±6.67)%、(35.55±5.70)%;LSM分别为(14.96±3.36)、(20.21±3.07)、(37.03±16.44)kPa,3组患者组间比较差异有统计学意义(P<0.01).轻、中、重3组患者的CTP评分比较差异无统计学意义(P>0.05).肝硬化组织病理学分级与LV萎缩率、LSM呈正相关(r=0.93、0.74,P<0.01),但与CTP评分无明显相关(r=0.27,P>0.05);LV萎缩率与LSM、CTP评分呈正相关(r-=0.90、0.91,P<0.01);LSM与CTP评分无明显相关(r=0.15,P>0.05).结论 肝硬化组织病理学分级程度越重,则LV萎缩率越大,FS检测值越高;LV萎缩率和LSM可以作为诊断肝硬化组织病理学严重程度的量化诊断指标.

关 键 词:肝炎  乙型  慢性  肝硬化  Laennec组织病理学分级  肝脏体积萎缩率  肝脏  瞬时弹性成像  Child-Turcotte-Pugh评分  hepatitis  type  B  chronic  liver  cirrhosis  Laennec  histopathological  classification  liver  volume  atrophy  rate  liver  fibroscan  Child-Turcotte-Pugh  scores

Rrelationship between liver volume atrophy rate,liver stiffness measurements and Child-Turcotte-Pugh value with Laennec histopathological classification in patients with hepatitis B cirrhosis
LIU Qincheng,LIU Ning,HAN Xiaoyu,GUO Linghong,WANG Chunming,LIAO Caixian.Rrelationship between liver volume atrophy rate,liver stiffness measurements and Child-Turcotte-Pugh value with Laennec histopathological classification in patients with hepatitis B cirrhosis[J].Chongqing Medical Journal,2018(14):1870-1873,1877.
Authors:LIU Qincheng  LIU Ning  HAN Xiaoyu  GUO Linghong  WANG Chunming  LIAO Caixian
Abstract:Objective To explore the relationship between the liver volume atrophy rate,liver stiffness measurements(LSM) and Child-Turcotte-Pugh(CTP) value with the Laennec histopathological classification in the patients with hepatitis B cirrhosis and its value in the quantitative diagnosis of liver cirrhosis degree.Methods The clinicopathological data of liver biopsy tissue pathological slides,FibroScan,CT examination and hematological detection in 32 cases of hepatitis B cirrhosis were retrospectively analyzed.Liver cirrhosis was divided into mild,moderate and severe according to the Laennec liver cirrhosis histopathological classification.Then the relationship between the liver volume atrophy rate,LSM and CTP score with liver cirrhosis histopathological.Results Among 32 cases,9 cases(28.12%) were mild,12 cases(37.50%) were moderate and 11 cases(34.38%) were severe.The liver volume atrophy rates of mild,moderate and severe groups were (16.75±2.20)%,(23.11±6.67)% and(35.55±5.70)% respectively;LSM were(14.96±3.36),(20.21± 3.07),(37.03 ± 16.44) kPa respectively,the difference among 3 groups was statistically significant (P< 0.01).The CTP scores had no statistical difference among the 3 groups were(P>0.05).The cirrhosis histopathological grade had the positive correlation with the liver volume atrophy rate and LSM(r=0.93,0.74,P<0.01),however had no obvious correlation with the CTP scores(r=0.27,P>0.05);the liver volume atrophy rate was positively correlated with LSM and CTP score(r=0.90,0.91,P<0.01);while LSM had no obvious correlation with CTP score (r =0.15,P > 0.05).Conclusion The more severe the cirrhosis histoathological grade,the bigger the liver volume atrophy rate and the higher the FibroScan detection value;the liver volume atrophy rate and LSM may serve as the quantitative diagnosis indicators of liver fibrosis histopathological severity.
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