肝纤维化及肝硬化肝脾体积变化的临床研究

目的 探讨肝脾体积改变对早期诊断肝纤维化及肝硬化的应用价值.方法 137例受检者接受多层螺旋CT(MSCT)动态增强检查,其中40例为无肝脏疾病的肝移植供体(对照组).63例经肝穿刺活检证实为肝纤维化患者,根据Ishak评分系统再分为轻度肝纤维化组(F≤2,44例)和显著肝纤维化组(F≥3,19例),34例经临床或影像学表现诊断为肝硬化失代偿(肝硬化组).进行全肝体积(TLV)、右半肝体积(RV)、左外叶体积(LLV)、左内叶体积(LMV)、尾状叶体积(CV)及脾脏体积(SV)测定,并分别计算上述各体积与TLV的比值.结果 对照组、轻度肝纤维化组、显著肝纤维化组及肝硬化组的TLV分别为1470.38、1239.99、1219.76、1078.21 cm3,RV分别为933.34、799.74、765.22、543.73 cm3,LMV分别为216.20、184.69、179.44、163.12 cm3,均呈降低趋势;而SV分别为256.29、284.41、343.13、863.38 cm3,CV/TLV分别为3.09%、3.20%、3.58%、4.16%,SV/TLV分别为17.53%、22.91%、28.80%、82.91%,均呈升高趋势.除轻度肝纤维化及显著肝纤维化组间差异无统计学意义(P＞0.05)外.其他各组间差异均有统计学意义(P＜0.05).TLV、LMV、SV、RV、RV/TLV、LLV/TLV、CV/TLV及SV/TLV与肝纤维化及肝硬化分期显著相关.结论 肝脾体积改变及肝脏各叶、SV/TLV有助于早期诊断肝纤维化及肝硬化.

Clinical study on volumetric variation of liver and spleen in liver fibrosis and cirrhosis

Objective To assess the volumetric variation of liver and spleen in early diagnosis of liver fibrosis and cirrhosis.Methods One hundred and thirty-seven subjects underwent dynamic enhanced examination of liver and spleen using multi-slice CT(MSCT).Forty potential living liver donors were served as controls.Sixty-three histologically proved fibrotic patients were divided into slight liver fibrosis(F≤2,n=44)and advanced liver fibrosis(F≥3,n=19)according to the Ishak system.Liver cirrhosis group consisted of 34 patients diagnosed clinically and radiologically.The measurement of total liver volume(TLV),right liver lobe volume(RV),left lateral liver segment volume(LLV),left medial liver segment volume(LMV),eaudate lobe volume(CV)and spleen volume(SV)were obtained bv MSCT.The ratios of segmental liver and SV to TLV were also calculated.Results The values of liver volumes(TLV,RV and LMV)reduced gradually among control(1470.38 cm3,933.34 cm3,216.20 cm3,respectively),slight liver fibrosis(1239.99 cm3,799.74 cm3,184.69 cm3,respectively),advanced liver fibrosis(1219.76 cm3,765.22 cm3,179.44 cm3,respectively)and cirrhosis(1078.21 cm3,543.73 cm3,163.12 cm3,respectively) groups.The volume of SV and the ratios of CV/TLV and SV/TLV increased gradually among control (256.29 cm3,3.09%,17.53%),slight liver fibrosis(284.41 cm3,3.20%,22.91%),advanced liver fibrosis(343.13 cm3,3.58%,28.80%)and cirrhosis(863.38 cm3,4.16%,82.91%)groups.There was significant difference among control,liver fibrosis and cirrhosis group in TLV,RV,LMV and SV/TLV(P＜0.05),but there was no significant difference in all parameters between the slight liver fibrosis group and the advanced liver fibrosis group(P＞0.05).There was significant correlation of TLV,LMV,SV,RV,CV/TLV,SV/TLV,RV/TLV and LLV/TLV with liver cirrhosis and its staging.Conclusion Variations in liver and spleen volume,the ratios of segmental liver and SV/TLV are correlated with the extent of liver fibrosis and cirrhosis.which will be helpful in early detection of liver fibrosis and cirrhosis.