磁共振虚拟肝血管三维重建在肝切除术中的应用

目的 探讨应用MR图像建立肝血管三维模型和虚拟肝切除在肝切除手术方案中的价值.方法 采用23例肝肿瘤患者肝脏静脉期MR图像重建肝血管三维模型,以任意角度显示肝脏、肿瘤及肝静脉、门静脉系统.在保证余肝充分门静脉供血及静脉回流的前提下行虚拟肝切除,计算拟切除肝体积及余肝体积,据此制定肝肿瘤切除手术方案并实施手术.结果 23例肝三维模型均可详细显示肝肿瘤及其血管解剖关系,虚拟肝切除评估肿瘤均可被切除.15例患者接受常规肝切除术,8例因肝右下静脉、肝中静脉变异或剥离肝中静脉而改变手术方案.23例肝肿瘤被完整切除,1例发生胆瘘,无肝功能衰竭病例.结论 肝肿瘤与血管MRI三维重建模型及虚拟肝切除术可用于指导肝肿瘤切除方案,减少术后并发症的发生.     

320排CT半自动法测量肝脏体积指数在肝硬化中的应用价值

目的 探讨320排CT半自动法测量肝脏体积(LV)指数在肝硬化中的应用价值。方法 使用320排螺旋CT半自动法测量肝硬化组20例和对照组20名的LV,并根据公式计算LV指数。绘制LV指数和LV测量值的ROC曲线,对肝硬化组的LV指数、LV测量值与肝功能血清学指标以及肝功能Child-Pugh评分分别进行相关分析。结果 肝硬化组的LV测量值为(997.31±293.37)cm³,LV指数为0.76±0.20;对照组的LV测量值为(1104.66±153.15)cm³,LV指数为0.88±0.11。LV测量值ROC曲线下的面积为0.68,LV指数ROC曲线下的面积为0.77。LV指数与肝功能Child-Pugh评分显著负相关(r=-0.54,P<0.05)。结论 LV指数能更好地反映肝硬化患者LV减小的程度,具有较高的敏感度和特异度,可用于辅助诊断肝硬化。     

Dynamic monitoring of serum liver function indexes in patients with COVID-19

BACKGROUNDSome patients with the novel 2019 coronavirus disease (COVID-19) display elevated liver enzymes. Some antiviral drugs that can be used against COVID-19 are associated with a risk of hepatotoxicity.AIMTo analyze the clinical significance of the dynamic monitoring of the liver function of patients with COVID-19. METHODSThis was a retrospective study of patients diagnosed with COVID-19 in January and February 2020 at the Department of Infection, Shantou Central Hospital. The exclusion criteria for all patients were: (1) History of chronic liver disease; (2) History of kidney disease; (3) History of coronary heart disease; (4) History of malignancy; or (5) History of diabetes. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase, and total bilirubin of patients with COVID-19 were measured on days 1, 3, 7 and 14 after admission, and compared to non-COVID-19 patents.RESULTSTwelve patients with COVID-19 (seven men and five women) and twelve controls (eight men and four women) were included. There were one, two, and nine patients with severe, mild, and moderate COVID-19, respectively. There were no differences in age and sex between the two groups (both P > 0.05). No significant differences were found in albumin, ALT, AST, γ-glutamyltransferase, or total bilirubin between the controls and the patients with COVID-19 on day 1 of hospitalization (all P > 0.05). Serum albumin showed a decreasing trend from days 0 to 7 of hospitalization, reaching the lowest level on day 7. Total bilirubin was higher on day 3 than on day 7. ALT, AST, and γ-glutamyltransferase did not change significantly over time. The severe patient was observed to have ALT levels of 67 U/L and AST levels of 75 U/L on day 7, ALT of 71 U/L and AST of 35 U/L on day 14, and ALT of 210 U/L and AST of 123 U/L on day 21.CONCLUSIONChanges in serum liver function indicators are not obvious in the early stage of COVID-19, but clinically significant changes might be observed in severe COVID-19.     

3D肝脏分析软件用于复杂型肝癌切除术前评估

目的 观察3D肝脏分析软件用于复杂型肝癌切除术前评估的价值。方法 收集60例原发性肝细胞癌（HCC）患者,其中30例于复杂型肝癌切除术前接受3D肝脏分析软件（3D组,n=30）、30例接受2D后处理软件（2D组,n=30）评估,比较组间手术时间、术中出血量、手术方式改变率和术后并发症发生率、术后住院时间、术后1年死亡率及1年复发率的差异,分析3D肝脏分析软件的价值。结果 3D组1例及2D组8例术中改变原计划手术方式,切除肝段数量增加或转为肝叶切除;3D组手术时间、术中出血量及手术方式改变率均明显少于2D组（P均<0.05）。结论 3D肝脏分析软件用于复杂型肝癌切除术前评估具有一定价值。     

磁共振定量测定儿童及青少年戈谢病肝脾脏体积及脂质含量

目的 探讨MRI定量分析儿童及青少年戈谢病患者肝脏、脾脏体积及脂质含量的价值。方法 对经骨髓穿刺证实的42例戈谢病患者（其中12例已行脾脏切除）行腹部MR检查,序列为冠状位三维梯度回波Dixon水脂分离（3D FFE mDIXON）和T2WI-STIR序列。所有患者均正在接受酶替代治疗。评估患者肝脏、脾脏脂质含量的差异及相关性。结果 42个肝脏校正的体积值为25.15~48.99 ml/kg,平均（33.66±6.03）ml/kg,脂质含量4.63%~10.09%,平均（5.90±1.10）%;30个脾脏校正的体积值为4.48~56.04 ml/kg,平均（16.36±10.65）ml/kg,脂质含量4.78%~19.39%,平均（6.63±2.62）%。同一患者脾脏脂质含量高于肝脏（t=2.16,P=0.04）。结论 采用MRI测量肝脾脏体积及脂质含量具有一定的可行性,可用于监测儿童及青少年戈谢病患者的病情及治疗效果。     

比较MR弹性成像及动态增强成像评价肝硬化食管胃底静脉曲张

目的 比较MR弹性成像（MRE）及动态增强成像（DCE-MRI）诊断肝硬化食管胃底静脉曲张（GEV）的价值。方法 收集接受MRE及DCE-MRI检查的肝硬化患者59例,记录血小板计数（PLT）,测量肝弹性值（HS）、脾弹性值（SS）和MR增强视觉分级相关指标;以内镜结果为金标准,采用ROC曲线下面积（AUC）比较相关指标诊断GEV的价值。结果 PLT、HS、SS及MR增强视觉分级与肝硬化GEV分级具有相关性（r_s=-0.317、0.436、0.682、0.703,P均<0.05）。诊断有无GEV时,SS的AUC略高于MR增强视觉分级、HS、PLT （AUC分别为0.880、0.795、0.744、0.635）,其中SS与PLT的AUC差异有统计学意义（P=0.002）;诊断中重度GEV时,MR增强视觉分级的AUC略高于SS、HS、PLT （AUC分别为0.893、0.816、0.713、0.665）,其中MR增强视觉分级与HS、PLT的AUC差异有统计学意义（P=0.018、0.002）。联合SS及MR增强视觉分级,鉴别诊断有无GEV及中重度GEV的敏感度分别为94.16%、96.83%。结论 MRE可有效预测GEV及其严重程度,与DCE-MRI效果相当。     

Does providing routine liver volume assessment add value when performing CT surveillance in cirrhotic patients?

Background

The measurement of liver volume (LV) is considered to be an effective prognosticator for postoperative liver failure in patients undergoing hepatectomy. It is unclear whether LV can be used to predict mortality in cirrhotic patients.

Methods

We enrolled 584 consecutive cirrhotic patients who underwent computerized topography (CT) of the abdomen for hepatocellular carcinoma surveillance and 50 age, gender, race, and BMI-matched controls without liver disease. Total LV (TLV), functional LV (FLV), and segmental liver volume (in cm³) were measured from CT imaging. Cirrhotic subjects were followed until death, liver transplantation, or study closure date of July 31, 2016. The survival data were assessed with log-rank statistics and independent predictors of survival were performed using Cox hazards model.

Results

Cirrhotic subjects had significantly lower TLV, FLV, and segmental (all except for segments 1, 6, 7) volume when compared to controls. Subjects presenting with hepatic encephalopathy had significantly lower TLV and FLV than those without HE (p = 0.002). During the median follow-up of 1145 days, 112 (19%) subjects were transplanted and 131 (23%) died. TLV and FLV for those who survived were significantly higher than those who were transplanted or dead (TLV:1740 vs. 1529 vs. 1486, FLV 1691 vs. 1487 vs. 1444, p < 0.0001). In the Cox regression model, age, MELD score, TLV, or FLV were independent predictors of mortality.

Conclusion

Baseline liver volume is an independent predictor of mortality in subjects with cirrhosis. Therefore, it may be useful to provide these data while performing routine surveillance CT scan as an important added value. Further studies are needed to validate these findings and to better understand their clinical utility.

     

Biliary stent combined with iodine-125 seed strand implantation in malignant obstructive jaundice

BACKGROUNDMalignant obstructive jaundice is mainly caused by cholangiocarcinoma. Only a few patients are indicated for surgical resection, and the 3-year survival rate is < 50%. For patients who are not eligible for surgery, biliary stent placement can relieve biliary obstruction and improve liver function and quality of life. However, restenosis after biliary stents has a poor prognosis and is a clinical challenge. Biliary stent combined with iodine-125 (¹²⁵I) seed implantation can prolong stent patency and improve survival.AIMTo evaluate the safety and efficacy of biliary stent combined with ¹²⁵I seed strand implantation in malignant obstructive jaundice. METHODSWe enrolled 67 patients between January 2016 and June 2018 with malignant obstructive jaundice and randomized them into a biliary stent combined with ¹²⁵I seed strand treatment (combined) group (n = 32) and biliary stent (control) group (n = 35). All patients underwent enhanced computed tomography and magnetic resonance imaging and were tested for biochemical and cancer markers. Twelve patients underwent pathological examination before surgery. All patients were followed up by telephone or clinical visit. Postoperative liver function improvement, postoperative complications, stent patency time, and survival time were compared between the two groups. Prognostic risk factors were evaluated. RESULTSTechnical success was achieved in all patients in both groups. Postoperative liver function improved significantly in all patients (total bilirubin, direct bilirubin, alanine aminotransferase, and aspartate aminotransferase decreased significantly in all patients, the P values were less than 0.05). There was no significant difference in preoperative or postoperative indexes between the two groups for changes in total bilirubin (P = 0.147), direct bilirubin (P = 0.448), alanine aminotransferase (P = 0.120), and aspartate aminotransferase (P = 0.387) between the two groups. The median stent patency time of the combined group was 9.0 ± 1.4 mo [95% confidence interval (CI): 6.3-11.8 mo], which was significantly longer than the that of the control group (6.0 ± 0.3 mo, 95%CI: 5.5-6.5 mo, P = 0.000). The median survival time of the combined group was 11.0 ± 1.4 mo (95%CI: 8.2-13.7 mo), which was significantly longer than that of the control group (7.0 ± 0.3 mo, 95%CI: 6.4-7.6 mo, P = 0.000). Location of obstruction and number of stents were independent risk factors affecting prognosis.CONCLUSIONBiliary stent combined with ¹²⁵I seed strand implantation is safe and effective in malignant obstructive jaundice and improves stent patency time and median survival time.     

再次肝移植围手术期输血治疗的探讨

目的探讨再次肝移植患者围手术期输血治疗及血液保护的规律与经验。方法随机抽取行两次肝移植手术患者12名,观察患者第1次与第2次手术间各指标差别,包括术前凝血功能、手术用时、血液丢失量、各类血液成分输入量、输液总量及临床预后等。结果2次手术术前凝血功能、所用时间、手术方式、无肝期时间、总入液量、总出液量及冷沉淀输入量无统计学差异(P>0.05);再次移植术中血液丢失量、红细胞悬液、血浆及血小板输入量明显增多(P<0.05)。结论在肝移植围手术期应根据患者的病情选择适当的血液制剂输注,合理应用相应的血液保护措施,并对凝血功能动态检测、恰当纠正,降低失血和输血量,提高肝移植患者的存活率。     

慢性乙型肝炎患者血清sST2与肝功能、血小板水平及Ishak评分的相关性

目的 观察慢性乙型肝炎(CHB)患者血清可溶性生长刺激表达基因2蛋白(sST2)的表达,并分析其与肝功能、血小板(PLT)水平、Ishak评分的相关性。方法 前瞻性地选取2018年12月至2020年12月大连市第六人民医院收治CHB患者190例,依据Ishak分为无纤维化(29例),纤维化(124例)、肝硬化(37例);另择同时期体检正常30例作为对照组。检测天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)、sST2、PLT水平,计算APRI,并分析。结果 4组受试者血清sST2、AST、ALT、ALB、TBIL、APRI、PLT比较差异显著(P<0.05)。无纤维化、纤维化及肝硬化患者血清sST2、AST、ALT、TBIL均显著高于对照组(P<0.05),ALB均显著低于对照组(P<0.05);肝硬化患者血清sST2、AST、ALT、TBIL均显著高于无纤维化、纤维化患者(P<0.05),ALB均显著低于无纤维化、纤维化患者(P<0.05),PLT显著低于对照组及无纤维化、纤维化患者(P<0.05)。Pearson结果显示,CHB患者sST2与AST、ALT、ALB、TBIL、PLT、APRI均呈相关(r=0.939、0.918、-0.816、0.795、-0.469、0.933,P<0.05);Spearman结果显示,CHB患者血清sST2与Ishak评分呈正相关(r=0.885,P<0.05)。多元线性回归模型,血清AST、ALT、ALB、TBIL、PLT及Ishak评分均是影响血清sST2的因素。ROC曲线显示,血清sST2、APRI及联合诊断肝硬化的AUC为0.715、0.789、0.806,敏感度分别为0.700、0.780、0.810,特异度分别为0.903、0.847、0.855。结论 血清sST2在CHB患者中异常升高,并随着肝纤维化的加重而升高;同时肝功能指标、PLT及Ishak评分均是血清sST2的影响因素,且血清sST2联合APRI可提高对CHB肝硬化的预测价值。     

Predictors of liver failure after transarterial chemoembolization in patients with spontaneously ruptured hepatocellular carcinoma: A retrospective study

BackgroundSpontaneously ruptured hepatocellular carcinoma (rHCC) is a life-threatening condition. Transarterial chemoembolization (TACE) is a widely accepted treatment; however, it can lead to serious complications, especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.MethodsPatients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve (AUC). Delong's test was used to compare predictive efficiency.ResultsSixty patients (19 and 41 in the liver failure and non-liver failure groups, respectively) were included. Multivariate analysis showed that preoperative prothrombin activity (PTA) level (odds ratio [OR], 0.956; 95% confidence interval [CI], 0.920–0.994; P ​= ​0.024) and Child-Pugh grade B (OR, 6.419; 95% CI, 1.123–36.677; P ​= ​0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were 0.783 and 0.764, respectively.ConclusionPreoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.     

Computed Tomography Measurements of Hepatic Steatosis in Cholelitihiasis and Cholecystectomy Cases Using Unenhanced Images

IntroductionComputed tomography (CT) measurements of hepatic steatosis can be performed using unenhanced CT images. The purpose of this study was to assess the occurrence of hepatic steatosis using unenhanced CT images for patients undergoing cholecystectomy or having cholelithiasis.MethodsA total of 143 unenhanced CT cases from a single centre were retrospectively examined. The CT number of liver, ratio of CT number of liver to spleen, and CT number of liver minus CT number of spleen were measured in three groups: (1) patients undergoing cholecystectomy, (2) patients having cholelithiasis, and (3) control group. Abdominal circumference, anterior subcutaneous fat tissue thickness, and body mass index were obtained.ResultsMean CT number of liver was significantly different between the group of patients with cholecystectomy and cholelithiasis and the control group (P < .001) and also between cases of cholecystectomy and cholelithiasis (P = .041), with the lowest CT number of liver in the cholecystectomy group. The mean CT number of liver minus CT number of spleen and mean CT number (liver/spleen) ratios, evaluated separately for both lobes, were not different comparing the cholelithiasis and cholecystectomy groups. The mean CT number of liver minus CT number of spleen and mean CT number (liver/spleen) ratios differed significantly between the control group and both patient groups (P < .001). Positive correlations were identified between abdominal circumference, subcutaneous fat depth, body mass index, and liver size and hepatic steatosis.ConclusionThere was an increased occurrence of hepatic steatosis in patients who have undergone a cholecystectomy compared with patients treated for cholelithiasis and the control group.     

Conversion therapy of hepatic artery ligation combined with transcatheter arterial chemoembolization for treating liver cancer: A case report

BACKGROUNDHepatocellular carcinoma is an aggressive tumor, and its latency and lack of clinical symptoms mean that most patients are already in the late stage when diagnosed. Large tumor volume and metastasis are the main reasons for not attempting surgery. Portal vein embolization and associated liver partition and portal vein ligation for staged hepatectomy are commonly used in clinical practice to increase the volume of remnant liver to allow surgical resection; however, research in this area is currently lacking.CASE SUMMARYA 48-year-old male patient with a history of viral hepatitis B for at least 30 years attended our center with a hepatic space-occupying lesion detected 3 d previously. Enhanced computed tomography scanning of the upper abdomen revealed a large mass in the right lobe of the liver, centered on the right posterior lobe, with the larger section measuring about 14 cm × 10 cm × 14 cm. He successfully underwent conversion therapy for a large right liver tumor after combined hepatic artery ligation and transcatheter arterial chemoembolization, and finally had an opportunity to undergo right hemi-hepatectomy and cholecystectomy. He remained asymptomatic with no obvious abnormalities on computed tomography scanning review at 2 mo after surgery.CONCLUSIONThis case highlights new ideas and provides a reference for conversion therapy of large liver tumors.     

Plasma brain natriuretic peptide,platelet parameters,and cardiopulmonary function in chronic obstructive pulmonary disease

BACKGROUNDChronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with worldwide occurrence and high disability and mortality rate. It occurs mostly in the elderly population with pulmonary heart disease, type II respiratory failure, and other serious complications.AIMTo investigate the correlation of plasma brain natriuretic peptide (BNP) and platelet parameters with cardiac function and pulmonary hypertension in patients with COPD and pulmonary heart disease. METHODSFrom June 2016 to June 2019, 52 patients with COPD-pulmonary heart disease (pulmonary heart disease group), 30 patients with COPD (COPD group), and 30 healthy individuals (control group) in our hospital were enrolled in the study. The pulmonary heart disease group was further divided into subgroups according to cardiac function classification and pulmonary artery pressure. Plasma BNP and platelet parameters were estimated and compared among each group and subgroup. The correlation of plasma BNP and platelet parameters with cardiac function classification and pulmonary artery pressure was then analyzed.RESULTSIn the pulmonary heart disease group, the COPD group, and the control group, the levels of plasma BNP, platelet distribution width (PDW), and mean platelet volume (MPV) showed a decreasing trend (P < 0.05), while an increasing trend was found in platelet count (PLT) and plateletcrit (PCT) levels among the three groups (P < 0.05). In the pulmonary hypertension mild, moderate, and severe subgroups, the levels of plasma BNP, PDW, and MPV showed an increasing trend (P < 0.05), while a decreasing trend was observed in PLT levels (P < 0.05); however, PCT levels showed no significant difference among the three subgroups (P > 0.05). In the cardiac function grade I, II, III, and IV subgroups, the levels of plasma BNP, PDW, and MPV showed an increasing trend (P < 0.05), while a decreasing trend was noted in PLT and PCT levels among the four subgroups (P < 0.05). Correlation analysis showed that the levels of plasma BNP, PDW, and MPV in patients with pulmonary heart disease were positively correlated with their pulmonary artery pressure (P < 0.05), while PLT was negatively correlated with their pulmonary artery pressure (P < 0.05). Moreover, plasma BNP, PDW, and MPV levels were positively correlated with cardiac function grade (P < 0.05) of these patients, while PLT and PCT levels were negatively correlated with their cardiac function grade (P < 0.05).CONCLUSIONPlasma BNP and PLT parameters are significantly correlated with the cardiac function and pulmonary hypertension in patients with COPD and pulmonary heart disease, indicating that these parameters have high clinical relevance in reflecting the health condition of these patients and for guiding their treatment.     

心脏MRI评估肺动脉高压患者的心功能

目的探讨心脏MRI(CMRI)评价肺动脉高压(PH)患者心室功能的临床价值。方法对30例PH患者(PH组)及30名健康志愿者(对照组)进行CMRI,分别计算右心室(RV)与左心室(LV)的舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、射血分数(EF)、舒张末期心肌质量(MM)等心功能参数,除EF外均经体表面积(BSA)校正,记为EDVI、ESVI、SVI、MMI。计算心室质量指数(VMI,为舒张末期RV MM与LV MM的比值)。采用两独立样本t检验分析两组参数有无差异。结果 PH组RV EDVI、ESVI及MMI均显著高于对照组(P均<0.01),RV EF显著低于对照组(P<0.01),两组RV SVI的差异无统计学意义(P>0.05)。PH组LV EDVI和SVI显著低于对照组(P均<0.05),而LV ESVI、EF及MMI与对照组的差异均无统计学意义(P均>0.05)。PH组VMI显著高于对照组(P<0.01)。PH组中23例(23/30,76.67%)患者LV舒张早期可见明显变形,其中室间隔变平10例,室间隔向左弓形突出13例。结论CMRI能够无创、准确地提供PH患者RV与LV的功能信息,对于评价PH患者心室功能具有重要价值。     

Effects of transjugular intrahepatic portosystemic shunt using the Viatorr stent on hepatic reserve function in patients with cirrhosis

BACKGROUNDAs transjugular intrahepatic portosystemic shunt (TIPS) creation alters the hemodynamic status of the portal system, whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention. Since the Viatorr stent entered the Chinese market in 2015, it has not yet been widely used in clinical practice. Further, unlike other countries, the main cause of liver cirrhosis in China is viral hepatitis. Therefore, use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIMTo investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODSClinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively. The patients were divided into three groups (A-C), according to their disease etiology, with post-hepatitis, autoimmune, and alcoholic cirrhosis, respectively. Preoperative and postoperative liver and renal function and coagulation data, Child-Pugh grade, and model for end-stage liver disease (MELD) scores were collected. Statistical analyses were performed using the t-test or chi-square test. The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTSThe surgical success rate was 100%, with mean portal pressure gradient (mmHg) decreasing from 25.5 ± 5.22 to 10.04 ± 2.76 (t = 45.80; P < 0.001). After 24 mo, the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C, while the cumulative survival rate was significantly higher in group A than in group B/C (P < 0.05 for both). The Child-Pugh score for group A was 6.96 ± 1.21, which was significantly better than those of groups B (7.42 ± 0.99; t = -2.44; P = 0.016) and C (7.52 ± 1.12; t = -2.67; P = 0.009). Further, the MELD score for group A (9.62 ± 2.19) was significantly better than those for groups B (10.64 ± 1.90; t = -2.92; P = 0.004) and C (10.82 ± 2.01; t = -3.29; P = 0.001).CONCLUSIONInsertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function. Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.     

原发性肝细胞癌患者根治术前预后多因素CT分析

目的 探讨原发性肝细胞癌(HCC)患者根治术前增强CT影像学征象与其预后的关系. 方法 回顾性分析87例接受根治切除术的原发性HCC患者术前临床及双期增强CT影像学资料,分析CT征象及根治术后复发转移及生存情况.采用Kaplan-Meier法,Log-rank时序检验进行单因素生存分析,将有统计学意义的指标依次引入Cox比例风险模型进行多因素分析. 结果全组1、3、5年术后生存率分别为80.18%、65.48%和42.09%.单因素生存分析显示,肿瘤大小、部位(单段病灶与多段病灶)、子灶、血管侵犯、动脉期肿瘤与肝实质CT值比值、门静脉期肿瘤与肝实质CT值比值对预后有影响(P<0.05).多因素Cox回归分析表明,血管侵犯、门静脉期肿瘤与肝实质CT值比值(<0.85)为影响预后的独立因素(P=0.037、0.007). 结论原发性HCC患者根治术后预后不良的主要CT征象包括血管侵犯和门静脉期肿瘤与肝实质CT值比值<0.85.     

多排CT诊断肥厚型心肌病：与MRI对照

目的 观察多排CT（MDCT）评价肥厚型心肌病（HCM）患者的心脏形态、功能和心肌纤维化等的准确性。方法 对临床诊断为HCM的60例患者行CT动脉期、延迟期扫描及心脏MR形态、延迟强化检查。比较二者在左心室室壁厚度、射血分数（EF）、每搏输出量（SV）、左心室心肌质量（LVM）、心输出量（CO）、心脏指数（CI）、舒张末期左心室容积（EDV）、收缩末期左心室容积（ESV）、延迟强化病灶定性及定量诊断方面的异同。结果 60例患者共1020个心肌节段,CT与MRI所测左心室室壁厚度的相关性好（r=0.895,P<0.001）,且CT测量的心功能参数均与MRI结果呈正相关。延迟增强检查证实CT与MR在检出心肌纤维化病灶方面具有高度相关性（r=0.98,P<0.01）。结论 心脏CT检查可提供HCM患者心肌冠状动脉的形态及功能信息。     

Performance of noninvasive tools for identification of minimal liver fibrosis in patients with hepatitis B virus infection

BackgroundVarious noninvasive liver fibrosis assessment tools are available. Here, we evaluated the performance of the asparagine aminotransferase‐to‐platelet ratio index (APRI), the fibrosis‐4 index (FIB‐4), transient elastography (TE), and the globulin–platelet (GP) ratio for identifying liver fibrosis in patients with hepatitis B virus (HBV) infection.MethodsA total of 146 patients were assessed using TE, FIB‐4, APRI, the GP ratio, and liver biopsy. Three patient grouping methods were applied: any fibrosis (AF; F0 vs. F1/2/3/4); moderate fibrosis (MF; F0/1 vs. F2/3/4); and severe fibrosis (SF; F0/1/2 vs. F3/4). Receiver operating characteristic (ROC) curve analysis, univariate analyses, and multivariate logistic regression were conducted.ResultsRegardless of patient‐grouping method, the area under the curve (AUC) of TE and the GP ratio were similar. Using the AF grouping method, the GP ratio showed superior performance compared with APRI and FIB‐4: the AUCs for the GP ratio, TE, APRI, and FIB‐4 were 0.76, 0.75, 0.70, and 0.66, respectively. Using the MF grouping method, the GP ratio also showed superior performance compared with APRI and FIB‐4: the AUCs for the GP ratio, TE, APRI, and FIB‐4 were 0.66, 0.68, 0.57, and 0.53, respectively. Using the SF grouping method, the AUCs for the GP ratio, TE, APRI, and FIB‐4 were not significantly different.ConclusionCompared with FIB‐4 and APRI, the GP ratio had higher accuracy for identifying liver fibrosis, especially early‐stage fibrosis, in patients with HBV infection.