CAJ | 학술논문

目的探讨肝硬化患者肾脏损害的CT表现,并对其影响因素进行研究.方法对60例经临床、实验室和影像学检查证实为肝硬化的患者和同期20例无肝肾疾患及其它相关疾病的患者行肾脏多层螺旋CT增强扫描,测量双肾皮质厚度,实质厚度,皮质厚度与实质厚度比,动脉期皮质、髓质强化程度.对肝硬化组肝功能不同Child-Pugh分级、不同腹水量、不同肝硬化类型、有无侧枝循环开放及脾静脉与左肾静脉有无交通间各测量指标进行亚组分析.结果肝硬化组皮质厚度与实质厚度比、动脉期皮质强化程度均较对照组低(P<0.05),髓质强化程度较对照组高(P<0.05).随着肝功能Child-Pugh分级的增高、侧枝循环开放及脾静脉与左肾静脉交通,皮质强化程度逐渐减低(P<0.05),而髓质强化程度、肾皮质实质厚度比无明显变化(P>0.05);不同腹水量及不同肝硬化类型间上述指标的差异无统计学意义(P>0.05).结论肝硬化患者肾脏损害的CT表现包括肾皮质厚度与实质厚度比减小、肾皮质强化程度减低、髓质强化程度增加等;其中肾皮质强化程度减低尤为重要,主要的影响因素包括肝功能损害的程度、有无侧枝循环开放及脾静脉与左肾静脉的是否交通.
목적 탐토간경화환자신장손해적CT표현,병대기영향인소진행연구.방법 대60례경림상、실험실화영상학검사증실위간경화적환자화동기20례무간신질환급기타상관질병적환자행신장다층라선CT증강소묘,측량쌍신피질후도,실질후도,피질후도여실질후도비,동맥기피질、수질강화정도.대간경화조간공능불동Child-Pugh분급、불동복수량、불동간경화류형、유무측지순배개방급비정맥여좌신정맥유무교통간각측량지표진행아조분석.결과 간경화조피질후도여실질후도비、동맥기피질강화정도균교대조조저(P<0.05),수질강화정도교대조조고(P<0.05).수착간공능Child-Pugh분급적증고、측지순배개방급비정맥여좌신정맥교통,피질강화정도축점감저(P<0.05),이수질강화정도、신피질실질후도비무명현변화(P>0.05);불동복수량급불동간경화류형간상술지표적차이무통계학의의(P>0.05).결론 간경화환자신장손해적CT표현포괄신피질후도여실질후도비감소、신피질강화정도감저、수질강화정도증가등;기중신피질강화정도감저우위중요,주요적영향인소포괄간공능손해적정도、유무측지순배개방급비정맥여좌신정맥적시부교통.
Objective To use CT to identify renal damage in patients with liver cirrhosis. Methods Sixty patients with liver cirrhosis confirmed by clinical, laboratory and imaging examinations and 20 patients without liver and kidney diseases (control group) were recruited in this study. The participants underwent double-stage enhanced scanning. The thickness of renal cortex (C) and parenchyma (P), and enhancement of renal cortex and medulla on cortical phase were measured. The association between renal damage and Child-Pugh grades, ascites capacities, liver cirrhosis types, opened portal collateral vessels, and opened collateral vessels between splenic venous and renal venous in the patients with liver cirrhosis were analysed. Results The patients with liver cirrhosis had lower C/P and enhancement of cortex on cortical phase and greater enhancement of medulla than the controls (P<0. 05). The enhancement of cortex decreased with the increase of Child-Pugh grade, opened portal collateral vessels and opened collateral vessels between splenic venous and renal venous (P<0. 05), but the differences of enhancement of medulla and C/P had no statistical significance (P>0. 05). No differences in the measured indicators were found between patients with different capacities of ascites and patients with different types of liver cirrhosis (P>0. 05). Conclusion The CT findings on renal damage in patients with liver cirrhosis include decrease in C/P and enhancement of cortex on cortical phase, and increase in enhancement of medulla on cortical phase. The enhancement of cortex on cortical phase is the most important change, which is associated with Child-Pugh grades, opened portal collateral vessels and opened collateral vessels between splenic venous and renal venous.