白蛋白与磁共振成像肝脏体积用于识别乙型肝炎相关肝硬化和食管静脉曲张。
Albumin and magnetic resonance imaging-liver volume to identify hepatitis B-related cirrhosis and esophageal varices.
作者信息
Li Hang, Chen Tian-Wu, Li Zhen-Lin, Zhang Xiao-Ming, Li Cheng-Jun, Chen Xiao-Li, Chen Guang-Wen, Hu Jia-Ni, Ye Yong-Quan
机构信息
Hang Li, Tian-Wu Chen, Xiao-Ming Zhang, Cheng-Jun Li, Xiao-Li Chen, Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China.
出版信息
World J Gastroenterol. 2015 Jan 21;21(3):988-96. doi: 10.3748/wjg.v21.i3.988.
AIM
To investigate whether liver lobe volume and albumin (ALB) could predict the presence and severity of liver cirrhosis, and esophageal varices.
METHODS
Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study. All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume, and biochemical workup for testing ALB and Child-Pugh class. All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices. Right liver lobe volume (RV), left medial liver lobe volume (LMV), left lateral liver lobe volume (LLV), and caudate lobe volume (CV) were measured using enhanced magnetic resonance imaging. The ratios of RV to ALB (RV/ALB), LMV to ALB (LMV/ALB), LLV to ALB (LLV/ALB) and CV to ALB (CV/ALB) were calculated. Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis, and the presence of esophageal varices.
RESULTS
RV, LMV, LLV and CV decreased (r = -0.51-0.373; all P < 0.05), while RV/ALB increased (r = 0.424; P < 0.05), with the progress of Child-Pugh class of liver cirrhosis. RV, LMV, CV, LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV, LMV, LLV, CV, RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV, RV/ALB and CV/ALB could identify presence of esophageal varices (all P < 0.05). Among these parameters, CV/ALB could best identify the presence of liver cirrhosis, with an area under receiver operating characteristic curve (AUC) of 0.860, a sensitivity of 82.0% and a specificity of 83.0%. LLV could best distinguish class A from B, with an AUC of 0.761, a sensitivity of 74.4% and a specificity of 73.1%. RV could best distinguish class A from C, with an AUC of 0.900, a sensitivity of 90.3% and a specificity of 84.5%. LLV/ALB could best distinguish class B from C, with an AUC of 0.900, a sensitivity of 93.8% and a specificity of 81.5%. RV/ALB could best identify esophageal varices, with an AUC of 0.890, a sensitivity of 80.0% and a specificity of 83.5%.
CONCLUSION
The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis, and presence of esophageal varices.
目的
探讨肝叶体积和白蛋白（ALB）能否预测肝硬化的存在、严重程度以及食管静脉曲张。
方法
本研究纳入71例乙型肝炎肝硬化患者和21名健康个体。所有参与者均接受腹部增强磁共振成像以测量各肝叶体积，并进行生化检查以检测ALB和Child-Pugh分级。所有肝硬化患者均接受上消化道内镜检查以显示肝硬化食管静脉曲张的存在。使用增强磁共振成像测量右肝叶体积（RV）、左内侧肝叶体积（LMV）、左外侧肝叶体积（LLV）和尾状叶体积（CV）。计算RV与ALB的比值（RV/ALB）、LMV与ALB的比值（LMV/ALB）、LLV与ALB的比值（LLV/ALB）以及CV与ALB的比值（CV/ALB）。进行统计分析以确定磁共振成像测量的肝叶体积与白蛋白的组合能否以及如何预测肝硬化的存在、严重程度以及食管静脉曲张的存在。
结果
随着肝硬化Child-Pugh分级的进展，RV、LMV、LLV和CV降低（r = -0.51 - 0.373；均P < 0.05），而RV/ALB升高（r = 0.424；P < 0.05）。RV、LMV、CV、LLV/ALB和CV/ALB可识别肝硬化的存在；LLV和LMV可区分Child-Pugh A级与B级；RV、LMV、LLV、CV、RV/ALB和LLV/ALB可区分A级与C级；RV和LLV/ALB可区分B级与C级；RV、RV/ALB和CV/ALB可识别食管静脉曲张的存在（均P < 0.05）。在这些参数中，CV/ALB对肝硬化存在的识别能力最佳，受试者工作特征曲线下面积（AUC）为0.860，灵敏度为82.0%，特异度为83.0%。LLV对区分A级与B级的能力最佳，AUC为0.761，灵敏度为74.4%，特异度为73.1%。RV对区分A级与C级的能力最佳，AUC为0.900，灵敏度为90.3%，特异度为84.5%。LLV/ALB对区分B级与C级的能力最佳，AUC为0.900，灵敏度为93.8%，特异度为81.5%。RV/ALB对食管静脉曲张的识别能力最佳，AUC为0.890，灵敏度为80.0%，特异度为83.5%。
结论
肝叶体积与ALB相结合有潜力识别肝硬化的存在、严重程度以及食管静脉曲张的存在。
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