[31P磁共振波谱与慢性病毒性肝炎患者肝脏组织病理学的关系]

[The relationship between 31P magnetic resonance spectroscopy and the histopathology of livers of chronic viral hepatitis patients].

作者信息

Wu Bi, Song Bin, Zhou Xiang-ping, Yang Yang, Lei Xue-zhong, Jiang Li-li

机构信息

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2007 May;15(5):338-41.

PMID:17524264

Abstract

OBJECTIVE

To investigate the correlations between 31P-magnetic resonance spectroscopy (MRS) findings and histopathological grading and staging of the livers of chronic viral hepatitis patients.

METHODS

Thirty-one patients with chronic viral hepatitis and 18 healthy volunteers were enrolled for this study. All of them underwent routine MRI plain scan and 31P-MRS of their livers. Peak areas of PME, PDE, PCr, Pi, gamma-ATP, beta-ATP and alpha-ATP were calculated. The concentrations of the phosphorus compounds of their livers, including PME, PDE, PCr, Pi, gamma-ATP, beta-ATP and alpha-ATP were measured. Percutaneous liver biopsies were performed on all 31 patients 0 to 7 days after their 31P-MRS examinations. Biopsy specimens were scored for fibrosis and necroinflammation according to the Knodell histological activity index. According to their necroinflammation scores, the 31 patients were divided into groups: slight hepatitis (7 patients), mild hepatitis (11), moderate hepatitis (8) and severe hepatitis (5). According to their fibrosis scores, the patients were divided into groups: no fibrosis (7 patients), portal fibrosis (11), bridging fibrosis (5) and cirrhosis (8).

RESULTS

The PME%, PDE% and PME/PDE of the hepatitis patients and of the control volunteers had significant statistical differences. The differences of PME%, PDE% and PME/PDE among different grades and stages also had statistical significance. When PME/PDE=0.78, 0.95 and 1.11 were set as the cut-off points for different grades of necroinflammation, and PME/PDE=0.79, 0.95 and 1.10 were set as the cut-off points for different stages of fibrosis, a sensitivity of 80.0%-87.5% and a specificity of 42.9%-72.7% were achieved.

CONCLUSION

PME/PDE is a sensitive marker for diagnosing the severity of chronic viral hepatitis. A rise of PME/PDE in hepatitis patients represents an increase of synthesis and a decrease in the breakdown of hepatocytes.

摘要

目的

探讨31P磁共振波谱（MRS）检查结果与慢性病毒性肝炎患者肝脏组织病理学分级及分期之间的相关性。

方法

本研究纳入31例慢性病毒性肝炎患者和18名健康志愿者。所有受试者均接受肝脏常规MRI平扫及31P-MRS检查。计算磷酸单酯（PME）、磷酸二酯（PDE）、磷酸肌酸（PCr）、无机磷（Pi）、γ-三磷酸腺苷（γ-ATP）、β-三磷酸腺苷（β-ATP）和α-三磷酸腺苷（α-ATP）的峰面积。测定肝脏中磷化合物（包括PME、PDE、PCr、Pi、γ-ATP、β-ATP和α-ATP）的浓度。在31例患者进行31P-MRS检查后的0至7天内，全部进行经皮肝穿刺活检。根据Knodell组织学活动指数对活检标本的纤维化和坏死性炎症进行评分。根据坏死性炎症评分，将31例患者分为轻度肝炎组（7例）、中度肝炎组（11例）、重度肝炎组（8例）和极重度肝炎组（5例）。根据纤维化评分，将患者分为无纤维化组（7例）、门脉纤维化组（11例）、桥接纤维化组（5例）和肝硬化组（8例）。

结果

肝炎患者与对照志愿者的PME%、PDE%及PME/PDE有显著统计学差异。不同分级和分期之间的PME%、PDE%及PME/PDE差异也有统计学意义。当将PME/PDE = 0.78、0.95和1.11分别设定为不同坏死性炎症分级的界值，将PME/PDE = 0.79、0.95和1.10分别设定为不同纤维化分期的界值时，敏感度为80.0% - 87.5%，特异度为42.9% - 72.7%。