慢性乙肝患者发生急性药物性肝损伤的超声特征分析

陈曦; 江峰; 张岩峰; 刘静; 刘晶晶; 冯卉; 皋月娟; 于杰; 刘方义

doi:10.12435/j.issn.2095-5227.2023.101

慢性乙肝患者发生急性药物性肝损伤的超声特征分析

Ultrasound features of acute drug-induced liver injury in patients with chronic hepatitis B

摘要

摘要:
背景我国乙肝患者众多，然而目前对于慢性乙型肝炎(chronic hepatitis B，CHB)患者发生急性药物性肝损伤(drug-induced liver injury，DILI)的研究甚少。
目的本研究旨在探讨CHB发生DILI的超声特点，并评估超声对乙肝合并药物肝损伤的诊断价值。
方法收集2017年1月 - 2019年12月在解放军总医院第五医学中心住院治疗的慢性乙肝合并急性药物性肝损伤(CHB-DILI)患者106例并匹配106例CHB患者。使用腹部超声检查，比较两组间肝实质回声、门静脉管壁厚度、脂肪肝、胆囊壁厚度、脾大小等指标，并在不同病理炎症分期和纤维化分期中对超声特征进行评估。
结果 CHB-DILI患者的中位年龄为38岁(范围：28 ~ 48岁)，CHB组中位年龄为36岁(范围：27 ~ 42岁)，差异无统计学意义。两组中均为男性患者居多(59.43% vs 63.21%，P=0.573)。与CHB患者相比，CHB-DILI患者肝实质回声减低发生率(35.85% vs 3.77%，P＜0.001)、门静脉管壁增厚发生率(32.08% vs 9.43%，P＜0.001)、脂肪肝发生率(39.62% vs 15.09%，P＜0.001)和胆囊壁增厚程度(5.07 ± 2.21) mm vs (3.89 ± 1.17) mm，P＜0.001更高。不同肝病理炎症分期和纤维化分期中，与CHB患者相比，CHB-DILI患者肝实质回声减低和门静脉管壁增厚发生率均更高(P＜0.05)。
结论结合用药史，慢性乙肝患者超声检查中的肝实质回声减低和门静脉管壁增厚等影像学特征，有助于急性药物性肝损伤的诊断。

Abstract:
Background There are many patients with hepatitis B in China, however, there are few studies on acute drug-induced liver injury (drug-induced liver injury, DILI) in patients with chronic hepatitis B (chronic hepatitis B, CHB).
Objective To explore the ultrasonographic features of DILI in CHB and evaluate the diagnostic value of ultrasound in hepatitis B complicated with drug-induced liver injury.
Methods A total of 106 patients with chronic hepatitis B complicated with acute drug-induced liver injury (CHB-DILI) and 106 patients with CHB were collected from January 2017 to December 2019 in the Fifth Medical Center of Chinese PLA General Hospital. Abdominal ultrasonography was used to compare the echo of liver parenchyma, the thickness of portal vein wall, the occurrence of fatty liver, the thickness of gallbladder wall and the size of spleen between the two groups, and the ultrasonic features were evaluated in different pathological inflammation and fibrosis stages.
Results The median age of patients with CHB-DILI was 38 years (range 28-48 years), and that of patients with CHB was 36 years (range 27 - 42 years). Most of the patients in both groups were male (59.43% vs 63.21%, P=0.573). Compared with patients with chronic hepatitis B, the incidence of hypoechoic liver parenchyma (35.85% vs 3.77%, P＜0.001), portal vein wall thickening (32.08% vs 9.43%, P＜0.001), fatty liver (39.62% vs 15.09%, P＜0.001) and gallbladder wall thickening (5.07 ± 2.21 mm vs 3.89 ± 1.17 mm, P＜0.001) were significantly higher in patients with chronic hepatitis B complicated with acute drug-induced liver injury. The incidences of hypoechoic liver parenchyma and portal vein wall thickening in patients with CHB-DILI were higher than those in patients with CHB in different pathological stages of inflammation and fibrosis (P＜0.05).
Conclusion Combined with the medication history, the ultrasound imaging features such as overall decreased echogenicity of the liver and accentuated brightness of the portal vein radicle walls in patients with chronic hepatitis B are helpful for the diagnosis of acute drug-induced liver injury.

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