利用3.0T MR探讨梗阻性黄疸肝内胆管表现与中医证型的相关性
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摘要
目的:利用超高场强MRI及MRCP探讨梗阻性黄疸肝内胆管扩张程度与中医黄疸辨证分型的关系,同时结合患者的总胆红素改变进行相关性探讨。方法:回顾分析76例梗阻性黄疸病例,由两名高年资中医师对患者进行中医辨证分型,分为阳黄、阴黄。通过MRI及MRCP测量肝内胆管扩张程度。采用SPSS23统计学方法,通过校正χ2检验和Fisher精确法,比较中医阴黄、阳黄在肝内胆管扩张分级及形态的相关性,并结合总胆红素及直接胆红素的排泄情况进行统计学检验,以P<0.05认为差异有统计学意义。结果:76例梗阻性黄疸患者中有阳黄47例、阴黄29例。阳黄与炎症、胆管结石关系密切,阴黄与胆管癌、胰头癌、壶腹周围癌、汇管区胆管癌关系密切。少数胆总管结石表现为阴黄。阳黄患者肝内胆管扩张分级以轻度、中度多见,肝内胆管扩张形态以"枯枝征"为主。阴黄患者肝内胆管扩张分级以中度、重度多见,肝内胆管扩张形态以"软藤征""空虚征"为主。梗阻性黄疸患者胆红素排泄数值在隐形黄疸和轻度黄疸范围内与阳黄关系密切;胆红素排泄数值在轻度黄疸、中度黄疸范围的患者与阴黄关系密切。结论:超高场强MRI及MRCP能够清晰显示梗阻性黄疸肝内胆管扩张程度,其影像表现与中医黄疸分型存在相关性。
Objective:To investigate the relationship between the degree of intrahepatic bile duct dilatation of obstructive jaundice and traditional Chinese medicine(TCM)syndrome differentiation of jaundice by ultra-high field magnetic resonance imaging(MRI)and magnetic resonance cholangiopancreatography(MRCP),and to discuss the correlation of total bilirubin changes. Methods:A retrospective analysis of 76 cases of obstructive jaundice was adopted,and TCM syndrome differentiation was performed on the patients by two senior Chinese medicine practitioners,which was divided into Yinhuang and Yang-huang. The degree of intrahepatic bile duct dilatation was measured by MRI and MRCP.Using SPSS23 statistical method,the chi-square analysis and Fisher's exact correction method were carried to compare the correlation of Yin-huang or Yang-huang in the classification and morphology of intrahepatic bile duct dilatation and statistical tests were performed with the excretion of total bilirubin and direct bilirubin. The test was considered to be statistically significant at P<0.05. Results:Of the 76 patients with obstructive jaundice,47 had Yang-huang and 29 had Yin-huang. Yang-huang was closely related to inflammation and bile duct stones. Yin-huang was closely related to cholangiocarcinoma,pancreatic head ductal carcinoma,periampullary carcinoma,and cholangiocarcinoma in the portal region. A few common bile duct stones appear as Yin-huang. The mild and moderate grade of intrahepatic bile duct dilatation are common in patients with Yang-huang,and the pattern of intrahepatic bile duct dilatation was mainly"deadwood sign". The moderate and severe grade of intrahepatic bile duct dilatation are common in patients with Yin-huang. The pattern of intrahepatic bile duct dilatation was mainly"soft rattan sign"and"empty sign". In patients with obstructive jaundice,the bilirubin excretion values were closely related to Yang-huang in the range of invisible jaundice and mild jaundice;patients with bilirubin excretion values in the range of mild jaundice and moderate jaundice were closely related to Yin-huang. Conclusion:Ultra-high field MRI and MRCP can clearly show the degree of intrahepatic bile duct dilatation in obstructive jaundice,and its imaging results are related to the syndrome differentiation of TCM jaundice.
Objective:To investigate the relationship between the degree of intrahepatic bile duct dilatation of obstructive jaundice and traditional Chinese medicine(TCM)syndrome differentiation of jaundice by ultra-high field magnetic resonance imaging(MRI)and magnetic resonance cholangiopancreatography(MRCP),and to discuss the correlation of total bilirubin changes. Methods:A retrospective analysis of 76 cases of obstructive jaundice was adopted,and TCM syndrome differentiation was performed on the patients by two senior Chinese medicine practitioners,which was divided into Yinhuang and Yang-huang. The degree of intrahepatic bile duct dilatation was measured by MRI and MRCP.Using SPSS23 statistical method,the chi-square analysis and Fisher's exact correction method were carried to compare the correlation of Yin-huang or Yang-huang in the classification and morphology of intrahepatic bile duct dilatation and statistical tests were performed with the excretion of total bilirubin and direct bilirubin. The test was considered to be statistically significant at P<0.05. Results:Of the 76 patients with obstructive jaundice,47 had Yang-huang and 29 had Yin-huang. Yang-huang was closely related to inflammation and bile duct stones. Yin-huang was closely related to cholangiocarcinoma,pancreatic head ductal carcinoma,periampullary carcinoma,and cholangiocarcinoma in the portal region. A few common bile duct stones appear as Yin-huang. The mild and moderate grade of intrahepatic bile duct dilatation are common in patients with Yang-huang,and the pattern of intrahepatic bile duct dilatation was mainly"deadwood sign". The moderate and severe grade of intrahepatic bile duct dilatation are common in patients with Yin-huang. The pattern of intrahepatic bile duct dilatation was mainly"soft rattan sign"and"empty sign". In patients with obstructive jaundice,the bilirubin excretion values were closely related to Yang-huang in the range of invisible jaundice and mild jaundice;patients with bilirubin excretion values in the range of mild jaundice and moderate jaundice were closely related to Yin-huang. Conclusion:Ultra-high field MRI and MRCP can clearly show the degree of intrahepatic bile duct dilatation in obstructive jaundice,and its imaging results are related to the syndrome differentiation of TCM jaundice.
引文
[1]韩萍,于春水.医学影像诊断学[M]. 4版.北京:人民卫生出版社,2017:425.
[2]吴勉华,王新月.中医内科学[M].3版.北京:中国中医药出版社,2012:252.
[3]Kordzaya DJ,Goderdzishvili VT. Batcherial translation in obstructive jaundice in rats;role of mucosal lacteals[J].Eur J Surg,2000,166(5):367-374.
[4]郭宇.梗阻性黄疸患者减黄术后血清与胆汁中胆红素含量同步变化的临床研究[D].太原:山西医科大学,2013.
[5]萧焕明,罗国亮,池晓玲.古代不同时期黄疸证治规律探析[J].中医杂志,2012,53(23):1998-2001.
[6]田芳,周自明,鲍虹,等.阻塞性黄疸阴黄、阳黄证的MRI表现[J].中国中西医结合影像学杂志,2012,10(6):489-491,523.
[7]向飞鹤,周新春,康人耀,等.MRCP对胆胰管良恶性梗阻的鉴别诊断价值[J].医学临床研究,2004(12):1442-1444.
[8]宋园园.MRI及MRCP在胆总管梗阻诊断中的定位及定性价值[J].中国实用医药,2015,10(9):58-59.
[9]焦振华,孟致辉,田治海,等.MRCP征象分析对胆道梗阻良恶性的诊断价值[J].肝胆胰外科杂志,2017,29(6):473-476.
[10]李绍东,徐凯,张秀莉,等.高场MRI动态增强联合MRCP在肝外癌性梗阻性黄疸中的应用[J].中国医学计算机成像杂志,2011,17(5):433-436.
[11]李彩霞,任翠萍,杜彦,等.MRCP对阻塞性黄疸的诊断价值探讨[J].中国现代医生,2010,48(24):58-59.
[12]贺俊景,姚家琪,周国兴,等.低位梗阻性黄疸中医辨证分型与超高场强MRCP影像改变的相关性探讨[J].中国中西医结合影像学杂志,2018,16(1):1-3,7.
[13]姚家琪,宋爱英,尹志伟.MRCP在梗阻性黄疸中医辨证分型中的应用研究[J].中国中西医结合影像学杂志,2007(6):401-403.
[14]金光华,季德刚,杨永生,等.梗阻性黄疸术前血清胆红素水平与术后并发症关系的探讨[J].中国实验诊断学,2006(8):892-894.
[15]高银,刘勇,宋震宇,等.高场MR多种成像技术与梗阻性黄疸中医辨证分型相关性研究[J].西南医科大学学报,2018,41(4):368-371.
[16]朱颖,殷东风,张烨.19例肿瘤合并黄疸患者中医辨证探讨[J].中医药导报,2018,24(12):49-51.
[17]张尹,曹峰,廖庆. MRCP联合高分辨率DWI对非结石性肝外胆管梗阻性病变定性诊断的初步研究[J].中国CT和MRI杂志,2015,13(8):67-69.
[18]黄振健,徐建良,蔡庆,等.肝门部恶性胆道梗阻的MRI、MRCP诊断价值[J].中国CT和MRI杂志,2012,10(6):73-75.
[19]Kang HJ,Lee JM,Joo I,et al. Assessment of Malignant Potential in Intraductal Papillary Mucinous Neoplasms of the Pancreas:Comparison between Multidetector CT and MR Imaging with MR Cholangiopancreatography[J]. Radiology,2016,279(1):128-139.
[2]吴勉华,王新月.中医内科学[M].3版.北京:中国中医药出版社,2012:252.
[3]Kordzaya DJ,Goderdzishvili VT. Batcherial translation in obstructive jaundice in rats;role of mucosal lacteals[J].Eur J Surg,2000,166(5):367-374.
[4]郭宇.梗阻性黄疸患者减黄术后血清与胆汁中胆红素含量同步变化的临床研究[D].太原:山西医科大学,2013.
[5]萧焕明,罗国亮,池晓玲.古代不同时期黄疸证治规律探析[J].中医杂志,2012,53(23):1998-2001.
[6]田芳,周自明,鲍虹,等.阻塞性黄疸阴黄、阳黄证的MRI表现[J].中国中西医结合影像学杂志,2012,10(6):489-491,523.
[7]向飞鹤,周新春,康人耀,等.MRCP对胆胰管良恶性梗阻的鉴别诊断价值[J].医学临床研究,2004(12):1442-1444.
[8]宋园园.MRI及MRCP在胆总管梗阻诊断中的定位及定性价值[J].中国实用医药,2015,10(9):58-59.
[9]焦振华,孟致辉,田治海,等.MRCP征象分析对胆道梗阻良恶性的诊断价值[J].肝胆胰外科杂志,2017,29(6):473-476.
[10]李绍东,徐凯,张秀莉,等.高场MRI动态增强联合MRCP在肝外癌性梗阻性黄疸中的应用[J].中国医学计算机成像杂志,2011,17(5):433-436.
[11]李彩霞,任翠萍,杜彦,等.MRCP对阻塞性黄疸的诊断价值探讨[J].中国现代医生,2010,48(24):58-59.
[12]贺俊景,姚家琪,周国兴,等.低位梗阻性黄疸中医辨证分型与超高场强MRCP影像改变的相关性探讨[J].中国中西医结合影像学杂志,2018,16(1):1-3,7.
[13]姚家琪,宋爱英,尹志伟.MRCP在梗阻性黄疸中医辨证分型中的应用研究[J].中国中西医结合影像学杂志,2007(6):401-403.
[14]金光华,季德刚,杨永生,等.梗阻性黄疸术前血清胆红素水平与术后并发症关系的探讨[J].中国实验诊断学,2006(8):892-894.
[15]高银,刘勇,宋震宇,等.高场MR多种成像技术与梗阻性黄疸中医辨证分型相关性研究[J].西南医科大学学报,2018,41(4):368-371.
[16]朱颖,殷东风,张烨.19例肿瘤合并黄疸患者中医辨证探讨[J].中医药导报,2018,24(12):49-51.
[17]张尹,曹峰,廖庆. MRCP联合高分辨率DWI对非结石性肝外胆管梗阻性病变定性诊断的初步研究[J].中国CT和MRI杂志,2015,13(8):67-69.
[18]黄振健,徐建良,蔡庆,等.肝门部恶性胆道梗阻的MRI、MRCP诊断价值[J].中国CT和MRI杂志,2012,10(6):73-75.
[19]Kang HJ,Lee JM,Joo I,et al. Assessment of Malignant Potential in Intraductal Papillary Mucinous Neoplasms of the Pancreas:Comparison between Multidetector CT and MR Imaging with MR Cholangiopancreatography[J]. Radiology,2016,279(1):128-139.