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χ^2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.
作者
潘鑫
姚家琪
周国兴
曲冰
温颖
曹丹娜
王丰
PAN Xin;YAO Jiaqi;ZHOU Guoxing;QU Bing;WEN Ying;CAO Danna;WANG Feng(Heilongjiang University of Traditional Chinese Medicine,Harbin 150040,Heilongjiang,China;First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine,Harbin 150040,Heilongjiang,China)
出处
《辽宁中医药大学学报》
CAS
2019年第8期93-96,共4页
Journal of Liaoning University of Traditional Chinese Medicine
基金
黑龙江省自然科学基金项目(H2015019)
