国人急慢性Budd-Chiari综合征患者临床和MRI特征对比

目的探讨国人急慢性Budd-Chiari综合征(BCS)患者临床和磁共振成像(MRI)特征差异。方法回顾性收集浙江医院收治的78例BCS患者临床和MRI资料。根据病程是否≤6个月,将患者分为急性组(n=32)和慢性组(n=46),比较两组患者临床和MRI特征。结果急慢性BCS患者临床特征比较显示,与急性组患者相比,慢性组年龄较大,下肢静脉曲张、下肢肿胀、下肢色素沉着、腹壁静脉曲张发生率较高,但肝功能指标和腹胀发生率较低,差异均有统计学意义(P<0.05);MRI特征比较显示,与急性组患者相比,慢性组腹水量较少、肝脏体积增大发生率较低,但尾状叶体积增大、肝内结节、肝内外交通支、副肝静脉发生率较高,差异均有统计学意义(P<0.05);急性组病变类型以肝静脉型为主,慢性组以混合型为主;急性组肝实质强化多不均匀,慢性组强化较为均匀。结论急慢性BCS临床特征和MRI表现均存在明显差异,观察这些特征表现有助于BCS准确分期和临床诊疗。

Comparison of clinical features and MRI manifestations between acute and chronic Budd- Chiari syndrome in Chinese patients

Objective To explore the differences of clinical features and magnetic resonance imaging(MRI)manifestations between acute and chronic Budd-Chiari syndrome(BCS)in Chinese patients.Methods The clinical data of MRI materials of 78 BCS patients,who were admitted to Zhejiang Hospital of China to receive treatment,were retrospectively analyzed.Based on the course of disease≤6 months or>6 months,the patients were divided into acute group(n=32)and chronic group(n=46).The clinical features and MRI manifestations were compared between the two groups.Results In chronic group the patients were older than those in the acute group;the incidences of varicose vein of lower limb,lower limb swelling,lower extremity hyperpigmentation,subcutaneous varicose vein of abdominal wall were higher than those in the acute group;while the serum levels of hepatic function indexes,including ALT,AST and TBIL,were lower than those in the acute group;and the differences were statistically significant between the two groups(P<0.05).When compared with the acute group,in the chronic group MRI showed less amount of ascites,lower incidence of liver enlargement,higher incidence of hepatic caudate lobe enlargement,more intrahepatic nodules,and higher incidence of intrahepatic-extrahepatic communicating branches and accessory hepatic veins;the differences in the above indexes between the two groups were statistically significant(P<0.05).The main type of BCS in the acute group was hepatic vein type,while the main type of BCS in the chronic group was mixed type.On contrast-enhanced MRI,inhomogeneous hepatic parenchymal enhancement was often observed in the acute group,while homogeneous hepatic parenchymal enhancement was usually seen in the chronic group.Conclusion Obvious differences in clinical features and MRI manifestations exist between acute and chronic BCS in Chinese patients.Understanding of these features and manifestations is helpful for making accurate staging and clinical diagnosis and treatment of BCS.