Diffuse liver disease
Introduction
Introduction "Diffuse liver disease" is a manifestation of liver tissue lesions in imaging studies, also known as liver fibrosis. Hepatic fibrosis is an excessive deposition of diffuse extracellular matrix in the liver. It is the result of a large amount of collagen deposited in the hepatic cell space stimulated by activated hepatic stellate cells under the stimulation of various pathogenic factors. If the fibrous tissue continues to proliferate, invade the liver cells, destroy the structure of normal liver tissue, form many nodules surrounded by fibrous tissue, and the liver texture becomes hard, which is cirrhosis.
Cause
Cause
Any cause such as hepatitis virus, schistosomiasis, alcohol, drugs and poisons that continue to damage the liver for a long time will lead to the formation of liver fibrosis, so the cause of liver fibrosis is diverse and complex.
Examine
an examination
Related inspection
Chest B ultrasound blood biochemistry six examination liver, gallbladder, spleen CT examination immunopathological examination
a, liver biopsy pathological examination is still the gold standard for the diagnosis of liver fibrosis, is an important basis for the diagnosis, measurement of inflammation activity, degree of fibrosis and determination of drug efficacy.
A semi-quantitative scoring system is currently generally employed. However, due to the uneven distribution of liver fibrosis in the liver, and the liver puncture tissue only accounts for 50,000 of the whole liver, it can cause diagnostic errors. Therefore, liver biopsy specimens are emphasized at least 15 mm and contain more than 6 confluence areas. Bedossa and other studies have shown that according to the METAVIR scoring system standard, such as liver permeation tissue is 15 mm, liver fibrosis diagnosis coincidence rate is 65%, such as liver permeation tissue is 25 mm, the coincidence rate is 75%, so the claim is not less than 25 Mm. In addition, liver biopsy is a traumatic examination, pain after puncture (24.6%) and other complications make half of the patients unwilling to accept the test. Therefore, it is imperative to explore the replacement of liver biopsy with non-invasive examination.
b, biochemical detection: serum HA, LN, PCIII, CIV can reflect the degree of liver fibrosis, especially HA and PCIII have the highest value of early liver fibrosis, but also affected by the degree of liver inflammation.
However, it is believed that the level of HA in patients with chronic hepatitis C is positively correlated with fibrosis grade and has little relationship with liver inflammation activity. It is also believed that CIV levels are associated with greater degrees of hepatic fibrosis and portal hypertension, but less with hepatic inflammatory activities. CAI Weimin et al. Using ROC curve to analyze the histopathological results of liver biopsy in 60 patients with chronic hepatitis B with platelet-derived growth factor BB (PDGFBB), transforming growth factor 1 (TGF1), matrix metalloproteinase inhibitor 1 (TIMP1), matrix metalloproteinase 1 (MMP1), HA, PCIII, CIV, LN and peripheral blood mononuclear cells (PBMC) were compared. The results showed that HA, PCIII, CIV and LN have certain value, and the diagnostic value of serum PDGF-BB is the largest.
In the screening of patients with liver fibrosis, the combination of serum PDGF-BB and TIMP1 mRNA was the best. In addition, domestic and foreign scholars have proposed that YKL40 (human cartilage protein 39) can be used to evaluate the degree of liver fibrosis.
The Fibrotest (FT) and ActiTest (AT) systems introduced in recent years provide a simple, non-invasive method for the evaluation of liver fibrosis. FT detects blood apolipoprotein A1, 2 macroglobulin, haptoglobin and total Bilirubin, which can easily and quickly and accurately quantify the degree of liver fibrosis (FT value is 0.00~1.00), while the ActiTest (AT) system can quantitatively evaluate the degree of inflammation and necrosis of the liver by detecting ALT and GGT (AT). The value is also 0.00~100). Naveau et al. performed liver biopsy, FT and HA tests in 221 patients with alcohol intake >50 g/d (mean 100 g/d). Liver biopsy was graded according to the METAVIR system, in which significant liver fibrosis (F2~F4) accounted for 63%.
The average value of FT is F0=0.29; F1=0.29; F2=0.40; F3=0.53; F4=0.88 (P values are <0.05 except for F0 and F1). There was no statistical difference between HA and F2 and F1 and between F2 and F0. For the diagnosis of F4, the UROC (area under the ROC curves) of FT and HA are very high, 0.95 and 0?93, respectively. Myers et al [8] studied 209 patients with HBV, of which 61 (29%) had a fibrosis stage of F2~F4, and FT was correctly evaluated (AUROC was 0.78±0.04).
For FT scores between 0.20 and >0.80, both positive and negative predictive values for liver fibrosis were 92%. Therefore, it is considered that only liver puncture is required for patients between FT>0.20 and 0.80 to clarify liver fibrosis and its extent. After reviewing 16 articles, Poynard pointed out that for patients with chronic HCV, FT and AT can replace liver puncture for evaluation of liver fibrosis and inflammatory necrosis. Liver puncture should be used as a second line, only for FT and AT results. Highly skeptical.
c. Imaging examination: B-ultrasound has a good correlation with liver surface, liver echo, hepatic vein, liver margin and spleen area and liver fibrosis stage, but it is difficult to distinguish in stage 1~3. It is also believed that changes in parameters such as blood flow parameters, spleen thickness, splenic vein width, and maximum oblique diameter of the right lobe of the portal vein and portal vein have a good correlation with the degree of liver fibrosis.
Color Doppler ultrasound can help to assess the degree of liver fibrosis, because liver fibrosis, hepatic artery blood flow velocity increases, portal vein blood flow velocity slows, so the ratio of the two (A / V) can be more comprehensively reflected Hemodynamic changes in liver fibrosis are superior to the detection of portal vein flow rate or hepatic vein spectrum changes. Fibroscan (FS) is a single-dimensional transient elastic diagram introduced in recent years. It is an instrument for measuring tissue hardness combined with ultrasonic (5 MHz) and low-frequency elastic waves (50 Hz). Since the hardness of the liver is related to liver fibrosis, the higher the reflected wave kPa, the heavier the degree of liver fibrosis. Sandrin et al reported that the FS reflected wave 5.1 kPa, 93% of patients with fibrosis degree belongs to F0 or F1, such as reflected wave 7.6 kPa, 94% of patients with fibrosis F2.
The advantages of FS are non-invasive, patients without pain, no complications, easy to operate, fast (<5 min), can be carried out in the clinic or bedside, due to quantification, the results are objective and reliable, reproducible. It is expected to replace liver puncture to diagnose and monitor the progression of liver fibrosis.
Diagnosis
Differential diagnosis
Identification:
Diffuse liver disease refers to a manifestation of liver tissue lesions in imaging studies. Diffuse liver lesions are common in patients with hepatitis B. The liver is destroyed by long-term replication of the virus. The liver forms a cord-like proliferative fibrous tissue in self-repair, which can destroy the normal structure of the liver and gradually increase with time. Can cause liver fibrosis. Different from hepatic hemangioma, hepatic cyst, liver cancer and other space-occupying lesions, viral hepatitis, fatty liver and liver fibrosis are diffuse lesions of the liver, because the distribution of these lesions in the whole liver is relatively consistent.
Diffuse liver parenchymal disease is a liver damage caused by long-term chronic inflammation of the liver. It is an organic change. This long-term development is often liver fibrosis and cirrhosis. When liver fibrosis occurs, the blood vessels in the liver are distorted by pressure, and it is easy to form portal hypertension, which leads to esophageal varices, ascites formation and splenomegaly, and there is a risk of rupture and bleeding in the vein. Second, intrahepatic fibrous tissue can block the blood passages in the liver, thereby affecting the repair of liver cells and even aggravating the damage. In severe cases, liver failure may occur.
