本文關(guān)鍵詞： 乙肝后肝硬化 組織病理學(xué)分級 臨床分期 Child-Pugh分級 MELD評分　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：1研究背景與目的乙肝后肝硬化是肝纖維化的終末階段,它的程度輕重以及硬化肝的功能狀態(tài),對于患者的生存和預(yù)后十分重要。在肝硬化程度評判方面,肝活檢術(shù)是金標(biāo)準(zhǔn);在肝功能狀態(tài)評估方面,臨床上常將肝硬化分為代償期和失代償期,另外Child-Pugh分級和MELD評分也應(yīng)用已久。但是,以上方法均存在或多或少的不足,亟待尋找新的手段來更好地評估肝硬化程度和肝功能狀態(tài)。在近年文獻報道的各種評估方法中,多層螺旋CT可精確測量活體肝臟體積,而肝臟體積變化是乙肝后肝硬化最基本的病理變化之一。但體積變化與組織學(xué)變化和功能學(xué)變化的相關(guān)關(guān)系怎樣,肝臟體積測量可否作為診斷肝硬化嚴重程度的一個量化指標(biāo),目前在這方面的文獻報道較少,并且在方案設(shè)計中多無同步進行組織病理學(xué)分級對比內(nèi)容。本研究通過探討CT肝臟體積測量與肝臟組織病理學(xué)分級、肝硬化臨床分期、Child-Pugh分級和MELD評分的關(guān)系,評估CT肝臟體積測量在肝硬化程度和肝功能狀態(tài)量化診斷中的價值。2方法收集2012年1月～2014年6月在南方醫(yī)科大學(xué)南方醫(yī)院住院治療、并且在住院期間接受了肝組織活檢術(shù)的乙型肝炎后肝硬化病例。經(jīng)過納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)篩選,最后獲得符合本研究條件的患者共30例。收集的臨床資料包括白蛋白、谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、凝血酶原時間的國際標(biāo)準(zhǔn)化比值、血小板計數(shù)、血肌酐。術(shù)前1周內(nèi)行胃鏡檢查明確有無食道胃底靜脈曲張,行腹部B超明確腹水情況。肝活檢術(shù)前1周內(nèi)采用64層螺旋CT薄層+三期增強掃描,獲得的圖像導(dǎo)入Mimics10.01軟件,進行肝臟三維重建,并計算CT肝臟體積。同時,根據(jù)《Baveno Ⅳ門脈高壓診斷和治療共識》的標(biāo)準(zhǔn)對患者進行肝硬化臨床分期。在術(shù)前48小時內(nèi),根據(jù)Child-Pugh評分標(biāo)準(zhǔn)和終末期肝病模型評分標(biāo)準(zhǔn)對患者進行Child-Pugh分級和MELD評分。肝活檢術(shù)后,根據(jù)Laennec組織學(xué)分級標(biāo)準(zhǔn)進行病理分級。分析各Laennec分級、臨床分期、Child-Pugh分級、MELD評分組之間的CT肝臟體積是否存在差異,以及前述分級/分期系統(tǒng)與CT肝臟體積的相關(guān)性。3結(jié)果30例患者的CT肝臟體積與理論肝臟體積相比較,前者顯著小于后者(P0.05)。CT肝臟體積變化與肝臟組織病理學(xué)分級、肝硬化臨床分期和MELD評分的變化均呈顯著性負相關(guān)(P0.01),相關(guān)系數(shù)(r)分別為-0.55、-0.78及-0.52;與Child-Pugh分級無明顯相關(guān)性(r=-0.34)。各Laennec分級、臨床分期、Child-Pugh分級、MELD評分組之間的CT肝臟體積,組間差異均有顯著性(P0.05);Child-Pugh A和B級組的CT肝臟體積差異無統(tǒng)計學(xué)意義(P0.05)。4結(jié)論乙肝后肝硬化患者的CT肝臟體積測量可以作為肝硬化的程度和功能狀態(tài)的一個量化診斷和評估指標(biāo)。
[Abstract]:1 background and objective liver cirrhosis is the end stage of liver fibrosis, its functional status and severity of liver cirrhosis, is very important for the survival and prognosis of patients with liver cirrhosis. In the evaluation, liver biopsy is the gold standard in the assessment of liver function; clinical aspects, often divided into liver cirrhosis during compensatory and in addition, Child-Pugh grading and MELD is used for a long time. However, these methods have some drawbacks, need to find new ways to better assess the degree of liver cirrhosis and liver function. In the various evaluation methods reported in the literature in recent years, multi-slice spiral CT can accurately measure the liver volume. The changes in liver volume is one of the basic pathological changes of hepatitis B cirrhosis. But the correlation between volume change and histological changes and functional changes, measurement of liver volume to be As a quantitative index for the diagnosis of liver cirrhosis severity, is reported in the literature in this area is less, and the design is not synchronized with the histopathological classification. Comparing the contents of this study was to explore the histological grade CT measurement of liver volume and liver pathology, clinical staging of liver cirrhosis, the relationship between Child-Pugh classification and MELD score, value.2 evaluation method for CT measurement of liver volume in liver cirrhosis and liver function in quantitative diagnosis from January 2012 to June 2014 hospitalized in the South Hospital of Southern Medical University, and in the hospital received liver biopsy after hepatitis B cirrhosis cases. Through the inclusion and exclusion criteria were obtained in this study were in 30 cases. The clinical data including albumin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, international standard Ratio, platelet count, serum creatinine. Preoperative gastroscopy within 1 week to determine whether esophageal varices, ascites underwent abdominal ultrasound. Clear liver biopsy within 1 weeks before the three phase enhanced 64 slice spiral CT thin + scanning, the images were imported into Mimics10.01 software, three-dimensional reconstruction of the liver, and calculation of CT liver volume. At the same time, according to the patients with liver cirrhosis and portal hypertension standard stage. In the 48 hours before surgery, the patients were according to the Child-Pugh classification and MELD score Child-Pugh standard for evaluation and model for end-stage liver disease and standard for evaluation. After liver biopsy, according to the Laennec histological classification the standard of pathological grading. Analysis of the Laennec classification, Child-Pugh classification, clinical stage, whether there is any difference between the MELD score of group CT liver volume, and the grading / staging system and CT liver volume The correlation between the results of.3 CT liver volume and liver volume theory in 30 patients were compared, the former was less than the latter (P0.05) classification of pathological changes in liver volume and liver.CT, liver cirrhosis clinical stage and MELD score showed a significant negative correlation (P0.01), correlation coefficient (R) were -0.55. -0.78 and -0.52; no significant correlation with Child-Pugh classification (r=-0.34). The Laennec classification, clinical stage, Child-Pugh grade, MELD score between group CT liver volume, the differences between groups were significant (P0.05); there was no significant difference between Child-Pugh A and CT liver volume B group (P0.05) conclusion.4 measurement CT the liver volume in patients with liver cirrhosis after hepatitis B can be used as the severity of liver cirrhosis and functional status of a quantitative diagnosis and evaluation index.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.2;R512.62

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