摘要
目的探讨基于钆塞酸二钠(gadolinium ethoxybenzyl diethylene triaminepentaacetic acid,Gd-EOB-DTPA)增强的MRI功能性肝脏成像评分(functional liver imaging score,FLIS)和自发性门体分流(spontaneous portosystemic shunts,SPSS)对慢性乙型肝炎(chronic hepatitis B,CHB)患者肝功能评估的价值;同时构建CHB患者首次失代偿事件的预测模型。材料与方法回顾性收集兰州大学第二医院2019年10月至2021年10月接受Gd-EOB-DTPA增强MRI扫描的268例CHB患者的临床和MRI资料。268例患者中,男192例,女76例,年龄21~77(48.5±9.4)岁。患者均在MR检查前后1周内有完整临床实验室检查资料。依据纤维化4(fibrosis 4,FIB-4)指数、Child-Pugh分级标准将患者分为4组:肝硬化前期慢性肝病(chronic liver disease,CLD)组、早期肝硬化(Child-Pugh A,CP A)组、中期肝硬化(Child-Pugh B,CP B)组、晚期肝硬化(Child-Pugh C,CP C)组。比较不同分组患者的临床实验室指标及FLIS、SPSS、脾脏头尾径(spleen craniocaudal diameter,SCCD)、门静脉宽度、脾静脉宽度等影像学参数,采用Friedman检验、卡方检验及方差分析进行相关性分析;采用Kappa一致性分析评价不同观察者间FLIS及其3个参数一致性;采用受试者工作特征(receiver operating characteristic,ROC)曲线比较各影像学参数对不同分组患者诊断效能;采用Cox回归分析不同分组间有差异的实验室及影像学参数,评估各参数对CHB患者发生首次失代偿事件的预测效能。结果(1)FLIS及其3个参数与临床分组中度-强相关(r=−0.464~−0.671,P<0.001)。(2)不同观察者间测量FLIS及其3个定量参数的一致性显著(一致性系数范围:0.931~1.000,P<0.001)。(3)区分CLD组与CP A组间的最优参数为SCCD,AUC为0.873(95%CI:0.769~0.904)。预测CLD组与CP A组及预测CP A与CP B组的FLIS最佳标准均为≥5分,而区分CP B与CP C组的最优标准是FLIS≥4分。预测CLD/CP A组与CP B/CP C区分的AUC为0.839(95%CI:0.790~0.889),而预测CP B与CP C的AUC为0.872(95%CI:0.820~0.924)。(4)FLIS不能作为CHB患者首次失代偿事件的独立预测因子(生存分析log-rank检验,P=0.203);单因素分析发现存在SPSS及SCCD≥13.4 cm均是首次失代偿发生的预测因子(风险比分别为:4.49、4.81,P<0.05)。二分法的SPSS结合SCCD可以提供对CHB患者首次失代偿事件更好的预测价值,AUC为0.708(95%CI:0.631~0.785)。结论FLIS在CHB患者肝功能分级中的诊断效能最佳,在对CHB患者首次失代偿事件预测中,SPSS及SCCD有较高的预测价值。
Objective:To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI functional liver imaging score(FLIS)and spontaneous portal shunt(SPSS)on the liver function assessment in patients with chronic hepatitis B(CHB)and to construct a prediction model for the first decompensation event in CHB patients.Materials and methods:A retrospective analysis was conducted on clinical and MRI data from 268 CHB patients who underwent Gd-EOB-DTPA-enhanced MRI at the Second Hospital of Lanzhou University between October 2019 and October 2021.The cohort included 192 males and 76 females,aged 21 to 77 years(mean±SD:48.5±9.4).All patients had complete clinical laboratory test results within one week before or after the MRI examination.Patients were stratified into four groups based on the Fibrosis-4(FIB-4)index and Child-Pugh(CP)classification:prehepatic cirrhosis chronic liver disease(CLD),early cirrhosis Child-Pugh A(CP A),mid-stage cirrhosis Child-Pugh B(CP B),and late cirrhosis Child-Pugh C(CP C).Comparison of clinical laboratory indicators and imaging parameters[FLIS,SPSS,spleen craniocaudal diameter(SCCD),portal vein width,splenic vein width]across groups using Friedman tests,chi-square tests and ANOVA for correlation analysis.Interobserver consistency of FLIS and its three components assessed via Kappa analysis.Diagnostic performance of imaging parameters for group differentiation evaluated using receiver operating characteristic(ROC)curves.Cox regression analysis of laboratory and imaging parameters with intergroup differences to predict the first decompensation event in CHB patients.Results:(1)FLIS and its three parameters were moderately to strongly correlated with clinical groups(r=−0.464 to−0.671,P<0.001).(2)Interobserver agreement for FLIS and its components was excellent(consistency coefficients:0.931 to 1.000,P<0.001).(3)SCCD was the optimal parameter for distinguishing CLD from CP A(AUC:0.873,95%CI:0.769 to 0.904).The FLIS cutoff value of≥5 best differentiated CLD/CP A from CP B/CP C(AUC:0.839,95%CI:0.790 to 0.889),while FLIS≥4 optimally separated CP B from CP C(AUC:0.872,95%CI:0.820 to 0.924).(4)FLIS was not an independent predictor of first decompensation in CHB patients(log-rank of survival analysis,P=0.203).Univariate analysis identified SPSS[hazard ratio(HR):4.49]and SCCD≥13.4 cm(HR:4.81)as significant predictors(P<0.05).The combination of SPSS(dichotomized)and SCCD provided superior predictive value for decompensation(AUC:0.708,95%CI:0.631 to 0.785).Conclusions:FLIS demonstrates optimal diagnostic performance for liver function grading in CHB patients.For predicting the first decompensation event in CHB patients,SPSS and SCCD exhibit significant predictive value.
作者
邹婕
姜艳丽
樊凤仙
杨品
杨文霞
李大瑞
刘阳
张静
ZOU Jie;JIANG Yanli;FAN Fengxian;YANG Pin;YANG Wenxia;LI Darui;LIU Yang;ZHANG Jing(Department of Magnetic Resonance,Lanzhou University Second Hospital,Lanzhou 730030,China;Second Clinical School,Lanzhou University,Lanzhou 730030,China;Gansu Province Clinical Research Center for Functional and Molecular Imaging,Lanzhou 730030,China)
出处
《磁共振成像》
北大核心
2025年第7期30-38,共9页
Chinese Journal of Magnetic Resonance Imaging
基金
甘肃省教育厅创新基金项目(编号:2022B-056)
甘肃省科技计划项目(编号:21JR7RA438)。
关键词
慢性乙型肝炎
乙肝肝硬化失代偿期
磁共振成像
钆塞酸二钠
功能性肝脏成像评分
chronic hepatitis B
hepatitis B virus decompensated cirrhosis
magnetic resonance imaging
gadolinium ethoxybenzyl diethylene triaminepentaacetic acid
functional liver imaging score
