慢性肝病和肝硬化患者钆塞酸增强MRI的肝功能成像评分的验证：Child-Pugh评分与肝功能成像评分的关系
doi: 10.12122/j.issn.1674-4500.2023.01.28
Verification of gadolinic acid enhanced MRI liver function imaging score in patients with chronic liver disease and cirrhosis: relationship between Child-Pugh score and liver function imaging score
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摘要:
目的 分析功能性肝脏成像评分（FLIS）在钆塞酸增强MRI中对肝功能的预测作用。 方法 将本院2019年10月~2022年2月收治的134例患者经钆塞酸增强MRI诊断为肝硬化或慢性肝病（CLD）的患者作为研究对象。评估FLIS肝胆期图像的3个参数：肝实质增强、胆汁排泄和门静脉信号强度，将其分为CLD（n=11）、Child-Pugh（CP）A级（n=87）、CP B级（n=22）、CP C级（n= 14）。采用Spearman秩相关法评估CP评分与FLIS及其各成分之间的相关性。通过ROC曲线分析得出FLIS的临界值，以区分不同CP类别。采用Cox比例风险模型评估患者特征、血清标志物、FLIS和肝功能失代偿之间的关系。 结果 FLIS及3个参数与CP评分呈强至极强相关性（r=-0.68、-0.60、-0.82、-0.80，P < 0.001）。ROC曲线分析结果显示，FLIS≥5是预测CP A类或CLD的最佳临界值（敏感度为83.7%，特异性为94.4%，曲线下面积为0.93）。FLIS < 5与CP A患者首次肝功能失代偿的发生独立相关（风险比为50.0，95% CI：6.2~400.4）。 结论 FLIS与肝功能有较强的相关性，可对CP分级进行分级。FLIS可以帮助预测首次失代偿的发展。 -
关键词:
- 慢性肝病 /
- 肝硬化 /
- 钆塞酸增强MRI /
- 肝功能成像评分 /
- Child-Pugh评分
Abstract:Objective To analyze the predictive effect of functional liver imaging score (FLIS) on liver function in gadolinium serate enhanced MRI. Methods A total of 134 patients admitted to our hospital from October 2019 to February 2022 who were diagnosed with cirrhosis or chronic liver disease (CLD) by gadolinium serate enhanced MRI were enrolled. Three parameters of FLIS hepatobiliary phase images were evaluated: hepatic parenchyma enhancement, bile excretion and portal vein signal intensity, which were divided into CLD (n=11), Child-pugh (CP) GRADE A (n=87), CP B (n=22) and CP C (n=14). Spearman rank correlation method was used to evaluate the correlation between CP score and FLIS and its components. The critical value of FLIS was obtained by ROC curve analysis to distinguish different CP categories. The relationship between patient characteristics, serum markers, FLIS, and liver decompensation were assessed using Cox proportional risk model. Results FLIS and three parameters were strongly correlated with CP score (r=-0.68, -0.60, -0.82, -0.80, P < 0.001). ROC curve analysis showed that FLIS≥5 was the optimal threshold for predicting CP CLASS A or CLD (sensitivity was 83.7%, specificity was 94.4% and the area under the curve was 0.93). FLIS < 5 was independently associated with the occurrence of first liver decompensation in patients with CP A (HR was 50.0, 95% CI: 6.2-400.4). Conclusion FLIS is strongly correlated with liver function, which can be used to grade CP. FLIS can help predict the development of first decompensation. -
图 1 65岁男性患者的慢性乙型肝炎和Child-Pugh A肝硬化行钆塞酸增强肝脏MRI检查
在肝胆相图像上, A: 门静脉相对于肝实质呈低信号（评分2）; B: 胆汁造影剂排泄至总胆管（白色箭头，评分2）, 肝实质相对于肾脏呈高信号（评分2）. 本例中3个FLIS参数的和是6.
Figure 1. Gadolinium seric acid enhanced liver MRI in a 65-year-old male patient with chronic hepatitis B and Child-Pugh A cirrhosis.
图 2 55岁的男性患者的慢性乙型肝炎和Child-Pugh B肝硬化行钆塞酸增强肝MRI检查
该患者经历了肝代偿。在肝胆期图像上, A: 门静脉相对于肝实质呈高信号（评分0）; B: 胆汁对比物排泄至胆总管（白色箭头，评分2）, 肝实质相对于肾脏呈等信号（评分1）. 本例中3个FLIS参数的和为3.
Figure 2. A 55-year-old male patient with chronic hepatitis B and Child-Pugh B cirrhosis underwent gadolinium seric acid-enhanced liver MRI.
图 3 预测CLD或CP A肝硬化的特异性和敏感度
Figure 3. Specificity and sensitivity for predicting CLD or CP A cirrhosis.
表 1 FLIS参数的相关性以及FLIS与CP评分系统的相关性
Table 1. Correlation of three FLIS parameters and the correlation be-tween FLIS and CP scoring system
参数 r P Child-Pugh评分 - - 肝实质增强质量评分 -0.68 < 0.001 胆汁造影剂排泄质量评分 -0.60 < 0.001 门静脉标志质量评分 -0.82 < 0.001 FLIS，以上3个分数之和 -0.80 < 0.001 FLIS: 功能性肝脏成像评分. 
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表 2 与肝功能失代偿发生相关的单因素和多因素Cox比例风险分析
Table 2. Univariate and multivariate Cox proportional risk analyses associated with hepatic decompensation
临床和MR特征 单变量 多变量 风险比 P 校正风险比 P FLIS评分 ≥5 1 1 < 5 50.0（6.2~400.4） < 0.001 50.0（6.2~400.4） < 0.001 总胆红素 < 34 1 ≥34 5.1（0.6~43.7） 0.14 白蛋白 ≥35 1 < 35 23.7（5.2~107.7） < 0.001 凝血酶原时间/国际标准化比值 < 1.7 1 ≥1.7 7.1（0.9~59.1） 0.07
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