瞬时弹性成像联合血清学标志物检测对肝纤维化的诊断效能分析

目的 血清学标志物联合检测对提高瞬时弹性成像技术(FibroScan)对肝纤维化诊断性能的影响.方法 选取慢性HBV感染患者313例,进行常规生化学检测、FibroScan检测及肝活检,绘制受试者工作特征(ROC)曲线,分析曲线下面积(AUROC),确定FibroScan、APRI、FIB-4诊断不同程度肝纤维化的界值...     

B超观察肠管和胆囊壁变化鉴别腹水性质的初步探讨（附210例分析）

1995年 1月～ 1998年 1月 ,我们共诊治肝硬化腹水和癌性腹水 145 0例。随机抽取 2 10例患者 ,其中肝硬化腹水患者15 3例 ,癌性腹水患者 5 7例。重点观察分析其肠管和胆囊壁的声像图特征与两种性质腹水间的关系。1　材料与方法　　本组 2 10例 ,均为住院患者 ,Ｂ超检查发现胆系疾患和肝硬化合并有肝癌者排除在外。男性 12 6例 (6 0 .0 % ) ,女性 84例 (4 0 .0 % ) ,年龄 38～ 77岁 ,平均 5 3.4岁。失代偿期硬化(肝硬化腹水组 ) 15 3例 ,癌性腹膜炎 (癌性腹水组 ) 5 7例 ,其中胃癌 2 3例 ,胰腺癌 9例 ,大小肠癌各 3例 ,子宫癌 5例 ,卵巢浆液性…     

肝硬化患者检测BNP的临床意义

目的 评价肝硬化患者检测BNP的临床意义.方法 将2015年2月—2016年2月在本院接受诊疗的48例肝硬化患者纳入研究(观察组),取同期健康体检者48例作为此次研究的对照组,对两组患者分别进行B-型钠尿肽(BNP)水平检测并进行对比评价.结果 (1)在BNP水平方面观察组明显比对照组高,两组数据差异有统计学意义(P<0.05);(2)从肝功能Child分级来看,级别越高BNP水平越高,C级和A级、B级比较,均存在明显统计学差异(P<0.05);(3)消化道出血、贫血、肾功能异常以及肝硬化腹水会使肝硬化患者的BNP的水平提高.结论 BNP水平能够反应患者病情的严重程度,同时BNP水平会受到消化道出血、贫血、肾功能异常以及肝硬化腹水的影响,需对这些因素引起重视.     

瞬时弹性成像诊断肝脏纤维化的准确性研究

目的 评估瞬时弹性成像(FibroScan)诊断肝纤维化的准确性.方法 选取解放军302医院2009年4-12月经病理检查诊断为肝纤维化的患者323例,其中141例患者行肝活检病理检查.全部患者临床检测肝功能、凝血指标、B超、血细胞计数,部分患者检测肝纤维化4项,患者均同时应用FibroScan进行肝脏硬度检测(LSM...     

腹水、血清降钙素原在肝癌、肝硬化患者中表达意义

目的探讨腹水、血清降钙素原(PCT)在肝癌、肝硬化患者中表达的意义。方法选取自2016年2月至2018年3月秦皇岛市第三医院收治的肝癌患者150例为肝癌组,再根据其有无细菌感染分为细菌感染组与非细菌感染组,每组各75例;选取同期收治的肝硬化患者150例为肝硬化组,再根据其有无自发性细菌性腹膜炎(SBP)分为SBP组及非SBP组,每组各75例。另选取同期收治的肝癌无感染患者75例为肝癌无感染组,肝硬化无感染患者75例为肝硬化无感染组。分别比较各组治疗前及治疗后、不同肝功能分级,以及肝癌及肝硬化不同预后患者的腹水、血清PCT水平。结果细菌感染组血清PCT水平高于肝癌无感染组及非细菌感染组,细菌感染组腹水PCT水平高于非细菌感染组,组间比较,差异均有统计学意义(P <0. 05);经治疗后,好转患者腹水、血清PCT水平均低于其治疗前及恶化患者,组间比较,差异有统计学意义(P <0. 05)。SBP组血清PCT水平高于肝硬化无感染组及非SBP组,腹水PCT水平高于非SBP组,组间比较,差异均有统计学意义(P <0. 05);经治疗后,好转患者腹水、血清PCT水平低于其治疗前及恶化患者,组间比较,差异有统计学意义(P <0. 05)。所有肝功能分级Child-Pugh C、B、A级患者的血清及腹水PCT水平逐次降低,组间两两比较,差异均有统计学意义(P <0. 05)。肝癌及肝硬化存活患者的腹水、血清PCT水平均低于病死患者(P <0. 05)。结论腹水、血清PCT水平检测可有效鉴别肝癌患者是否伴有细菌感染、肝硬化患者是否伴有SBP,且其对两种疾病预后及患者肝功能判断也有一定价值。     

肝组织学炎症程度对瞬时弹性成像检测值的影响

目的 观察肝组织学炎症程度对瞬时弹性成像技术(FibroScan)检测值的影响.方法 选取2009年4月-2010年12月在解放军302医院诊断为慢性肝炎的住院患者282例,均行肝穿刺组织学检查及FibroScan检测.按纤维化0-2级(F0-2)和3-4级(F3 4)将患者分为两组,比较不同炎症程度患者FS值的差异;...     

腹穿与利尿对比对肝硬化自发性细菌性腹膜炎的相关研究

腹穿治疗肝硬化腹水不但安全而且价廉,易被接受。近来一些研究(Hepatology,1995;21:340)显示用利尿剂治疗肝硬化腹水能增加腹水蛋白浓度及调理素水平,不易发生自发性细菌性腹膜炎(SBP),但腹穿则与此相反。鉴于这种理由,我们对肝硬化腹水患者分别采取腹穿与利尿治疗,随访观察与SBP的关系。 1 病例与方法 1.1 病例:1992年2月～1994年6月88例肝硬化腹水患者,随机分两组,Ⅰ组(腹穿组)43例,腹穿放水加输注白蛋白20～40g(每放1L腹水输注白蛋白6～8g);Ⅱ组(利尿组)45例,安体舒通、双氢克     

肝硬化患者左旋氧氟沙星口服后腹水中浓度的检测

目的　研究左旋氧氟沙星口服后 ,在肝硬化患者腹水中的药物分布及动态变化。方法　收集 7例肝硬化合并腹水患者口服左旋氧氟沙星后 ,不同时间点的腹水标本 ,采用高效液相法 ,检测其中药物浓度并观察其动态变化。结果　口服 2h后 ,即可在腹水中检测到 ,并随时间推移而逐渐升高 ,腹水中达药物高峰时间 (T max　 )约 6 .0h ,腹水药物峰浓度 (C max　 )2 .5 2 0± 1.2 13μg·ml-1。此后逐渐下降 ,至 12h趋于稳定。结论　左旋氧氟沙星口服后 ,较短时间内在患者的腹水中有分布 ,并可形成高峰浓度 ,30 0mg口服后 ,腹水中有效药物浓度可持续时间长达 12h以上     

腹腔内注射多巴胺速尿治疗重度腹水11例体会

<正> 肝硬化腹水(livercirrhosi and ascitesLCA)的药物疗法有数十种之多,我科自1993年9月始采用腹腔内注入多巴胺速尿治疗肝硬化(LC)重度腹水11例,效果满意,现将结果报告如下     

肝硬化门脉高压大量腹水伴脐疝患者的护理

目的 总结肝硬化门脉高压大量腹水伴脐疝患者内科保守治疗期间的护理经验.方法 回顾性分析2012年1月至2020年1月收治的22例肝硬化门脉高压大量腹水伴脐疝患者的临床资料.结果 22例肝硬化门脉高压大量腹水伴脐疝患者采取腹腔穿刺置管放腹水、降门脉压等专科治疗,同时通过细致的病情观察,精心的皮肤护理、管道护理、心理护理,...     

Value of acoustic radiation force impulse elastography for the assessment of ascites syndrome

AIM:To assess the feasibility of performing acoustic radiation force impulse(ARFI) elastography in patients with ascites and its predictive value for the cirrhotic or non-cirrhotic etiology of ascites.METHODS:Our study included 153 patients with ascites,mean age 58.8 ± 13.1 years.One hundred and fifteen(75.2%) patients had ascites in the context of cirrhosis,29(18.9%) had non-cirrhotic ascites(diagnosed by clinical,ultrasound,endoscopic and/or laparoscopic criteria) and in 9(5.9%) cases we could not establish the etiology of ascites.We performed 10 ARFI measurements and the median value was calculated and expressed in meters/second(m/s).Among the 29 patients with non-cirrhotic ascites were included:20 laparoscopically demonstrated peritoneal carcinomatosis with histological confirmation,7 acute pancreatitis with ascites which later resolved,and one case each of lymphatic ascites and ascites in the context of a liver abscess.In 11 of the 20 patients with peritoneal carcinomatosis,the liver structure was homogenous in the ultrasound examination and in 9 patients the ultrasound exam revealed liver metastases.RESULTS:We could not obtain valid ARFI measurements in 5 patients(3.2%).The mean liver stiffness measurements by means of ARFI were statistically significantly higher in patients with cirrhotic ascites than in those with non-cirrhotic ascites:3.04 ± 0.70 vs 1.45 ± 0.59 m/s(P < 0.001).For a cut-off value of 1.8 m/s for predicting cirrhosis(and ascites in the context of cirrhosis),as obtained in a previous study,ARFI had 98.1% sensitivity,86.2% specificity,96.4% positive predictive value,92.5% negative predictive value and 95.6% accuracy for predicting cirrhotic ascites.For a cut-off value of 1.9 m/s the accuracy was 94.9% and for a 2 m/s cut-off value it was 92.8%.CONCLUSION:ARFI elastography is feasible in most patients with ascites and has a very good predictive value for the cirrhotic or non-cirrhotic etiology of ascites.     

部分脾动脉栓塞术治疗肝硬化性脾功能亢进的临床评价

目的探讨部分脾动脉栓塞术(PSE)对治疗肝硬化性脾功能亢进的疗效及临床价值。方法对20例肝硬化性脾功能亢进患者进行了PSE;观察术前术后外周血象的变化、腹水消退及并发症发生情况。结果 20例患者术后外周血象较术前明显改善。8例有腹水者,腹水消失6例,腹水减少2例。术后并发症主要有左上腹疼痛(15例)、发热(10例)、左侧胸水(3例)。结论 PSE对治疗肝硬化性脾功能亢进症有明显疗效和重要的临床价值。选择合适的病人和严格的操作技术能避免严重并发症的发生。     

Value of computed tomography and magnetic resonance imaging for assessing severity of liver cirrhosis secondary to viral hepatitis

PURPOSE: The aim of this study was to assess the value of abdominal CT and MRI in determining the severity of cirrhosis secondary to hepatitis compared to Child-Pugh classification. MATERIALS AND METHODS: The study included 23 patients who were clinically and histologically diagnosed with chronic liver disease secondary to viral hepatitis. Each patient underwent dynamic abdominal CT imaging and MRI within the same week. CT and MRI findings were retrospectively reviewed. The same parameters were used from the CT and the MR images for each patient. The parameters included liver volume index (posterior segment of the right lobe, medial and lateral segments of the left lobe), spleen volume index, ascites, portosystemic collaterals, contour irregularities of the liver and confluent fibrosis within the liver. The findings were compared with the patients' Child-Pugh grades. Multiple regression analysis was used for statistical analysis. RESULTS: On MRI, liver volume index (P = 0.0001), and ascites (P = 0.009) were strongly correlated with Child-Pugh grades. With CT, only ascites was correlated with Child-Pugh grades (P = 0.002). CONCLUSION: This study indicates that liver volume index on MRI, and ascites on CT and MRI are good indicators of clinical severity of cirrhosis secondary to hepatitis. To show the effect of the other parameters, more research is needed with larger patient groups.     

不同肝功能分级肝硬化患者的食管压力测定

为了解不同肝功能分级肝硬化患者食管蠕动功能和食管压力变化的特点，选择肝硬化患者（肝硬化组）94例，均经临床或病理确诊为肝硬化且有食管静脉曲张，肝功能Child分级；A组38例，有8例伴发腹水，B级37例，有20例伴发腹水；C级19例，有18例伴发腹水，另选择无肝硬化的正常对照（正常对照组）72例，均无消化系统疾病及胃肠道症状，无腹部手术，外伤史。检查前7天停用所有影响胃肠动力的药物。采用美国Sandhill公司Biolab食管动力检测系统及配套分析软件。结果显示，肝硬化肝功能A－C级各组食管下段括约肌静息压依次降低，松弛压力增大，松弛率变小；肝硬化组食管上段蠕动波起始点速度变慢，蠕动性收缩减少，异常收缩增加；肝硬化肝功能A－C级各组食管体部下段蠕动压力幅值依次降低，蠕动波起始点速度变慢，蠕动性收缩减少，异常收缩增加。以上结果表明，肝硬化患者肝功能损害越重，对食管正常动力影响越大，同时肝硬化患者食管静脉曲张与腹水形成亦有协同作用。     

Clinical usefulness of scintigraphy with 99mTc-galactosyl-human serum albumin for prognosis of cirrhosis of the liver.

Scintigraphy with 99mTc-diethylenetriamine pentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) is useful for evaluating hepatic functional reserve. We assessed the clinical usefulness of this technique, including its value in establishing a prognosis, in patients with cirrhosis of the liver. METHODS: Scintigraphy with 99mTc-GSA was performed in 10 healthy subjects, 42 patients with chronic hepatitis and 158 patients with cirrhosis. Computer acquisition of gamma camera data were started just before the injection of 99mTc-GSA. Time-activity curves for the heart and liver were generated from regions of interest (ROIs) for the heart and the entire liver. A receptor index was calculated by dividing the radioactivity of the liver ROI by that of the liver-plus-heart ROI 15 min after the injection. An index of blood clearance was calculated by dividing the radioactivity of the heart ROI at 15 min by that of the heart ROI at 3 min. RESULTS: The median receptor index was lower in patients with cirrhosis than in patients with chronic hepatitis or in healthy subjects, and the median index of blood clearance was higher. The receptor index was significantly lower when a complication (varices, ascites) was present. The index of blood clearance was significantly higher when a complication (varices and ascites) was present. Correlation of the two indices with classic indicators for functional reserve was significant. On the basis of the receptor index, the patients with cirrhosis were divided into two groups of roughly equal size: group A, receptor index over 0.85, and group B, receptor index 0.85 or less. On the basis of the index of blood clearance, the patients with cirrhosis were divided into two groups of roughly equal size: group A, index of blood clearance < 0.70, and group B, index of blood clearance > or = 0.70. The cumulative survival rates were lower in group B than in group A. CONCLUSION: Scintigraphy with 99mTc-GSA is clinically useful, especially in establishing the prognosis of patients with cirrhosis of the liver.     

介入性腹腔腔静脉分流术治疗顽固性腹水

目的：评价介入性腹腔腔静脉分流术对终末期肝功能失代偿患者并发顽固性腹水的治疗效果。材料与方法：７例转流患者年龄２２～７０岁，平均４８．１岁。选择两端多侧孔分流导管，在腹腔与上腔静脉之间建立转流，术中测定腹腔内压和上腔静脉压，术后记录腹围改变，监测其肝肾功能指标。结果：腹腔腔静脉压力差均值为１２２．９ｍｍＨ２Ｏ，腹围平均缩小１１．４ｃｍ（７～１５ｃｍ）；术后肝肾功能指标得到改善，其中５例临床症状明显缓解。结论：介入性腹腔腔静脉分流术具有操作简便和少创性特点，对于改善终末期肝功能失代偿合并大量腹水患者的生活质量具有确切疗效     

肝硬化Child-Pugh分级与LGV内径关系的MSCTA分析研究

目的探讨胃左静脉(LGV)和门静脉(PV)内径与肝硬化Child-Pugh分级间的关系。资料与方法应用16层螺旋CT对100例肝硬化患者和200名正常对照者行上腹部增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)和容积重组(VR)对PV和LGV进行血管重建,测量LGV和PV主干的直径并进行统计学分析。结果总体肝硬化组LGV和PV管径与正常对照组比较明显增粗(P<0.05)。Child-A级和B级组PV最大内径较正常对照组和Child-C级组显著增粗(P<0.05)。Child-C级组和正常对照组、Child-A级和B级组PV最大内径比较差异无统计学意义(P>0.05)。正常对照组、肝硬化无腹腔积液组、肝硬化有腹腔积液组LGV内径逐渐增粗且差异具有统计学意义(P<0.05)。结论多层螺旋CT血管成像(MSCTA)可以清晰显示LGV和PV整体解剖结构,并能准确测量其内径,LGV和PV内径与肝硬化程度存在一定关系,但影响LGV和PV内径因素较多,不能单纯依靠管径大小评价肝硬化程度。     

Overestimation of splenic size and underestimation of hepatic size by radiocolloid scintigraphy in advanced cirrhosis of the liver: an autopsy correlation

The radiocolloid liver-spleen scintigrams of seven patients with advanced cirrhosis of the liver were correlated with autopsy results. The data showed scintigraphic overestimation of splenic size and underestimation of hepatic size. The causes of underestimation of the liver size were: rotation of the liver due to ascites; photon attenuation by ascitic fluid; and/or decreased and in homogeneous distribution of radiocolloid in the diseased liver. The splenic size/weight was overestimated because of lack of the effects of ascites and the usually marked increase in splenic radioactivity. Awareness of the underestimation of the liver weight/size and overestimation of the splenic weight/size occurring on the radiocolloid liver-spleen scan of patient with advanced alcoholic cirrhosis of the liver may help avoid misinterpretation.