3.0T磁共振弹性成像评估胆道梗阻的临床研究

摘要/Abstract

摘要： 目的 3.0T磁共振弹性成像测量不同胆道梗阻状态肝脏硬度值,探讨其与血清标志物和致病因素的相关性。方法纳入2020年6月至2022年12月秦皇岛市中医医院诊治的70例胆道疾病患者,其中胆道梗阻患者35例,均行胆道梗阻解除术治疗。采用3.0T磁共振弹性成像检测肝脏硬度值;检测血生化指标,比较胆道梗阻、非胆道梗阻患者临床资料。结果非胆道梗阻患者肝脏硬度值、总胆红素、TBA、ALT、AST、GGT水平分别为(2.3±0.4)kPa、(9.9±3.8)μmol/L、(4.8±1.5)μmol/L、(65.1±14.2)IU/L、(35.1±8.5)IU/L、(71.7±12.3)IU/L,低于胆道梗阻患者的(4.5±1.1)kPa、(248.6±45.2)μmol/L、(53.6±8.4)μmol/L、(136.8±16.5)IU/L、(99.8±28.7)IU/L、(464.2±53.9)IU/L,差异均有统计学意义(P<0.05)。非胆道梗阻患者中,致病良性因素患者20例,明显多于胆道梗阻患者11例;致病恶性因素患者15例,明显少于胆道梗阻患者24例(P<0.05)。致病因素为良性和恶性的患者中,非胆道梗阻患者的肝脏硬度值分别为(2.3±0.4)kPa、(2.3±0.3)kPa,均小于胆道梗阻患者的(3.7±0.9)kPa、(4.7±0.9)kPa,差异均有统计学意义(P<0.05);在胆道梗阻患者中,致病因素恶性患者的肝脏硬度值(4.7±0.9)kPa,明显高于致病因素良性患者的(3.7±0.9)kPa,差异均有统计学意义(P<0.05)。肝脏硬度值与患者血清总胆红素及GGT水平高度线性相关(r=0.657、0.545,P<0.01),与患者血清ALT、AST水平呈低度线性相关(r=0.334、0.312,P<0.01)。35例胆道梗阻患者均接受胆道引流术,与手术前肝脏硬度值(5.3±0.4)kPa及胆红素(226.5±51.4)μmol/L相比,手术后均明显下降,分别为(2.5±0.3)kPa、(16.5±4.2)μmol/L( P<0.05)。结论 3.0T MRE显示胆道梗阻患者的肝脏硬度值增加,且与致病因素的良恶性无关,及早解除胆道梗阻后可下降。MRE测量肝脏硬度值可作为预测胆道引流术后胆道减压效果的无创检测标准。

关键词: 胆道梗阻, 胆汁淤积, 肝脏硬度值, 磁共振弹性成像

Abstract: Objective To investigate the change of liver stiffness and its correlation with serum markers and pathogenic factors in biliary patients after biliary drainage by 3.0T magnetic resonance elastography(3.0T magnetic resonance elastography). Methods 70 patients with biliary tract diseases diagnosed and treated in our hospital between June 2020 and December 2022 were enrolled. Among them, 35 patients were diagnosised with biliary obstruction and underwent biliary obstruction relief surgery. Liver stiffness was detected by 3.0T magnetic resonance elastography, and blood biochemical indexes were detected by automatic biochemical analyzer. The clinical data of patients with biliary obstruction and non-biliary obstruction were compared. Results The liver stiffness values, total bilirubin, TBA, ALT, AST and GGT levels in patients with non-biliary obstruction were (2.3±0.4) kPa, (9.9±3.8) μmol/L, (4.8±1.5) μmol/L, (65.1±14.2) IU/L, (35.1±8.5) IU/L, and (71.7±12.3) IU/L, respectively, which were significantly lower than those in patients with biliary obstruction [4.5±1.1) kPa, (248.6± 45.2)μmol/L,(53.6±8.4)μmol/L,(136.8±16.5)IU/L,(99.8±28.7)IU/L and(464.2±53.9)IU/L,P<0.05]; Among patients with non-biliary obstruction, the number of patients with pathogenic benign factors was 20, which was significantly higher than that of patients with biliary obstruction in 11. The number of patients with pathogenic malignant factors was 15 cases significantly less than that of patients with biliary obstruction (P<0.05). The liver stiffness of patients with non-biliary obstruction were (2.3±0.4) kPa and (2.3±0.3) kPa lower than those of patients with biliary obstruction [(3.7±0.9) kPa, (4.7±0.9) kPa, P＜0.05], respectively; In patients with biliary obstruction, the liver stiffness (4.7±0.9) kPa in patients with malignant causative factors was significantly higher than that in patients with benign causative factors [(3.7±0.9) kPa, P ＜0.05]; The liver stiffness was highly linearly correlated with the serum total bilirubin and GGT levels (r₁=0.657, r₂=0.545, P＜0.01), and was linearly correlated with the serum ALT and AST levels (r₁=0.334, r₂=0.312, P＜0.01), and 35 patients with biliary obstruction underwent biliary drainage compared with (5.3±0.4) kPa and (226.5±51.4) μmol/L. After surgery, the liver stiffness and bilirubin level significantly decreased [(2.5±0.3) kPa, (16.5±4.2) μmol/L, P＜0.05, respectively]. Conclusion 3.0T MRE showed that liver stiffness was increased in patients with obstruction, which is not related to benign or malignant causative factors, but could decrease after early relief of biliary obstruction. Therefore, the measurement of liver stiffness by 3.0T MRE can be used as a non-invasive detection standard to predict the effect of biliary decompression after biliary drainage, which is worthy of clinical application.

Key words: Biliary obstruction, Cholestasis, Liver stiffness, Magnetic resonance elastography

王方旭, 赵志军, 徐明露, 姚仲欣, 王倩. 3.0T磁共振弹性成像评估胆道梗阻的临床研究[J]. 肝脏, 2025, 30(7): 988-991.

WANG Fang-xu, ZHAO Zhi-jun, XU Ming-lu, YAO Zhong-xin, WANG Qian. Clinical study of 3.0T MRE to evaluate biliary obstruction[J]. Chinese Hepatolgy, 2025, 30(7): 988-991.

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