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肝硬化是我国常见疾病之一,其伴随的肝功能减退在临床上常表现为内分泌紊乱,可导致肝脏对雌激素的灭活作用减弱,干扰丘脑-垂体-性腺轴[1]的正常活动,使性激素水平失衡,从而引起男性乳腺的病理性发育,且中老年男性为高发人群[2]。本文旨在通过现有影像学资料的研究,探讨肝硬化与老年男性乳腺发育症是否存在相关性,从而为临床干预提供一定依据。现作报道。
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乳腺发育症组病人V乳腺为30~250 mL不等,其中40例呈丘状或锥体样隆起型乳腺,10例呈弥漫性增大型乳腺,3例呈扁平状增大。大多病人R乳/表分级1级(21/53,39.62%)或2级(23/53,43.40%)。其中19例呈单侧增大,且以左侧增大为主,34例呈双侧增大,单侧和双侧乳腺增生病人的R乳/表分级差异有统计学意义(P < 0.01)(见图 2~4、表 1)。乳腺发育症组53例中,有37例为初次入院治疗,其中20例表现为乳腺1级增大,17例为2级增大,且均为Child-Pugh分级A或B级;16例因肝硬化及其并发症多次入院治疗(3~4次),其中9例为乳腺3级增大,且Child-Pugh分级为B或C级,6例2级增大者和仅有的1例1级增大者均为Child-Pugh分级A级。
分组 1级 2级 3级 uc P 单侧乳腺增生 12 6 1 2.69 < 0.01 双侧乳腺增生 9 17 8 合计 21 23 9 表 1 单侧和双侧乳腺增生病人的R乳/表分级比较(n)
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2组病人V乳腺、R乳/表、Child-Pugh分级、Child-Pugh评分和肝硬化CT分级差异均有统计学意义(P < 0.01),而V病肝、R肝差异均无统计学意义(P>0.05)(见表 2)。
分组 n V乳腺/mL R乳/表/ (mL/m3) V病肝/cm3 R肝/% Child-Pugh分级/级 Child-Pugh评分/分 肝硬化CT分级/级 A B C 0 Ⅰ Ⅱ Ⅲ 乳腺发育组 53 118.63±28.50 73.30±18.76 862.09±225.20 -28.31±6.69 12 36 5 9.58±2.15 0 15 33 5 无乳腺发育组 70 24.14±4.60 9.58±2.27 914.28±282.41 -26.33±7.24 34 32 4 7.16±2.24 0 37 30 3 t — 23.90* 24.59* 1.11 1.55 2.83* 6.04 2.76* P — < 0.01 < 0.01 >0.05 >0.05 < 0.01 < 0.01 < 0.01 *示uc值 表 2 2组病人相关影像学指标比较(x±s)
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根据Child-Pugh分级法将2组病人分别分为A、B、C级,其中乳腺发育症组病人V乳腺、R乳/表随肝功能分级的增加均有增加趋势(P<0.05~P < 0.01),且与无乳腺发育组各对应分级比较差异均有统计学意义(P < 0.01);2组病人病变肝脏的V病肝、R肝随肝功能分级增加均有减小趋势(P < 0.01),但乳腺发育症组各肝功能分级病人与无乳腺发育症组相应肝功能分级比较差异均无统计学意义(P>0.05)(见表 3)。
分组 n V乳腺/mL R乳/表/(mL/m3) V病肝/cm3 R肝/% 乳腺发育症组 肝功能A级 12 95.93±14.46 62.37±17.63 1 081.93±274.09 -15.18±6.03 肝功能B级 36 115.13±19.94** 72.62±15.26 883.62±173.68** -30.29±6.96** 肝功能C级 5 129.70±25.76* 83.55±20.94 676.50±79.13**# -44.62±9.24**## F — 6.65 3.32 8.55 36.31 P — < 0.01 < 0.05 < 0.01 < 0.01 MS组内 — 377.408 266.465 38 143.816 48.738 无乳腺发育症组 肝功能A级 34 22.18±4.58△△ 9.15±2.72△△ 1 046.51±275.39 -14.97±5.99 肝功能B级 32 23.76±4.75▲▲ 9.93±3.08▲▲ 874.14±162.60** -29.39±7.35** 肝功能C级 4 25.20±5.33▽▽ 9.98±2.95▽▽ 663.28±83.41** -41.06±6.23**## F — 1.37 0.64 8.30 54.09 P — >0.05 >0.05 < 0.01 < 0.01 MS组内 — 22.043 8.422 49 898.235 44.405 q检验:与肝功能A级比较*P < 0.05,**P < 0.01;与肝功能B级比较#P < 0.05,##P < 0.01。与乳腺发育症组肝功能A级比较△△P < 0.01;与乳腺发育症组肝功能B级比较▲▲P < 0.01;与乳腺发育症组肝功能C级比较▽▽P < 0.01 表 3 2组病人不同肝功能分级间的相关影像学指标比较(x±s)
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V乳腺、R乳/表与肝功能Child-Pugh分级、涂氏肝硬化CT分级均呈明显正相关关系(P < 0.01),V病肝、R肝与肝功能分级、涂氏肝硬化CT分级均呈明显负相关关系(P < 0.01)(见表 4)。
指标 Child-Pugh分级 涂氏肝硬化CT分级 V乳腺 0.592** 0.588** R乳/表 0.804** 0.794** V病肝 -0.871** -0.861** R肝 -0.895** -0.878** **P < 0.01 表 4 乳腺发育症组病人影像学指标与肝功能分级的相关性(r)
肝硬化老年男性病人影像指标与乳腺发育症的相关性分析
Correlation analysis between the imaging indexes and gynecomastia in elderly male patients with liver cirrhosis
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摘要:
目的探讨综合使用各类影像学手段建立老年男性肝硬化与乳腺发育症相关性的可行性。 方法选取肝硬化老年男性病人123例为研究对象,年龄均>60岁。确定病人Child-Pugh分级,根据是否乳腺发育分为乳腺发育症组(n=53)和无乳腺发育症组(n=70)。采用CT、MRI或BUS影像学资料估算病人乳腺体积(V乳腺)、体表面积(BSA)、标准化乳腺体积(R乳/表)、正常肝脏体积(V肝脏),区域增长或容积测算技术测定病变肝脏体积(V病肝)、肝脏体积变化率(R肝),涂氏肝硬化影像学分级评估肝脏图像。 结果乳腺发育症组病人中19例呈单侧增大,34例呈双侧增大,单侧和双侧乳腺增生病人的R乳/表分级差异有统计学意义(P < 0.01)。2组病人V乳腺、R乳/表、Child-Pugh分级、Child-Pugh评分和肝硬化CT分级差异均有统计学意义(P < 0.01),而V病肝、R肝差异均无统计学意义(P>0.05)。根据Child-Pugh分级法将2组病人分别分为A、B、C级,其中乳腺发育症组病人V乳腺、R乳/表随肝功能分级的增加均有增加趋势(P < 0.05~P < 0.01),且与无乳腺发育组各对应分级比较差异均有统计学意义(P < 0.01);2组病人病变肝脏的V病肝、R肝随肝功能分级增加均有减小趋势(P < 0.01),但2组各相应肝功能分级间比较差异均无统计学意义(P>0.05)。乳腺发育症组病人的V乳腺、R乳/表与肝功能Child-Pugh分级、涂氏肝硬化CT分级均呈明显正相关关系(P < 0.01),V病肝、R肝与肝功能分级、涂氏肝硬化CT分级均呈明显负相关关系(P < 0.01)。 结论综合使用各类影像学手段测量肝硬化老年男性病人的乳腺体积增大情况,可以帮助推断和评估病人肝功能损害和肝脏萎缩程度。 Abstract:ObjectiveTo explore the feasibility of using various imaging methods to establish the correlation between the severity of cirrhosis and gynecomastia in elderly men. MethodsA total of 123 elderly male patients with liver cirrhosis aged >60 years were selected as the research object.The Child-Pugh grade of patients was determined.According to the breast development, the patients were divided into the breast development group(n=53) and non-breast development group(n=70).The CT, MRI or BUS imaging data were used to estimate the breast volume(Vbreast), body surface area(BSA), normalized breast volume(Rbreast/surface) and normal liver volume(Vliver).The regional growth or volume measurement techniques were used to measure the volume of diseased liver(Vliver disease) and rate of change of liver volume(Rliver), and the imaging grading of smear cirrhosis was used to evaluate the liver images. ResultsThere were 19 cases of unilateral enlargement and 34 cases of bilateral enlargement in the breast development group.The difference of the Rbreast/surface grade between unilateral and bilateral breast hyperplasia patients was statistically significant(P < 0.01).The differences of the Vbreast, Rbreast/surfac, Child-Pugh grade, Child-Pugh score and CT grade of liver cirrhosis between two groups were statistically significant(P < 0.01), while the differences of the Vdisease liver and Rliver were not statistically significant(P>0.05).According to the Child-Pugh grading method, the patients in the two groups were divided into the A, B and C grades, respectively.The Vbreast and Rbreast/surface of patients in the breast development group showed an increasing trend with the increase of liver function grade(P < 0.05 to P < 0.01), and the differences of which was statistically significant compared with those in the non-breast development group(P < 0.01).The Vdisease liver and Rliver of the diseased liver in two groups showed a decreasing trend with the increase of liver function grade(P < 0.01), but there was no statistical significance in the corresponding liver function grade between two groups(P>0.05).There were significant positive correlations among the Vbreast, Rbreast/surface, Child-Pugh grade of liver function and CT grade of smear cirrhosis(P < 0.01), while there were significant negative correlations among the Vdisease liver and Rliver and liver function grade and CT grade of smear cirrhosis(P < 0.01). ConclusionsThe comprehensive use of various imaging methods to measure the enlargement of breast volume in elderly male patients with cirrhosis can help to infer and evaluate the degree of liver function damage and liver atrophy. -
Key words:
- liver cirrhosis /
- gynecomastia /
- imaging
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表 1 单侧和双侧乳腺增生病人的R乳/表分级比较(n)
分组 1级 2级 3级 uc P 单侧乳腺增生 12 6 1 2.69 < 0.01 双侧乳腺增生 9 17 8 合计 21 23 9 表 2 2组病人相关影像学指标比较(x±s)
分组 n V乳腺/mL R乳/表/ (mL/m3) V病肝/cm3 R肝/% Child-Pugh分级/级 Child-Pugh评分/分 肝硬化CT分级/级 A B C 0 Ⅰ Ⅱ Ⅲ 乳腺发育组 53 118.63±28.50 73.30±18.76 862.09±225.20 -28.31±6.69 12 36 5 9.58±2.15 0 15 33 5 无乳腺发育组 70 24.14±4.60 9.58±2.27 914.28±282.41 -26.33±7.24 34 32 4 7.16±2.24 0 37 30 3 t — 23.90* 24.59* 1.11 1.55 2.83* 6.04 2.76* P — < 0.01 < 0.01 >0.05 >0.05 < 0.01 < 0.01 < 0.01 *示uc值 表 3 2组病人不同肝功能分级间的相关影像学指标比较(x±s)
分组 n V乳腺/mL R乳/表/(mL/m3) V病肝/cm3 R肝/% 乳腺发育症组 肝功能A级 12 95.93±14.46 62.37±17.63 1 081.93±274.09 -15.18±6.03 肝功能B级 36 115.13±19.94** 72.62±15.26 883.62±173.68** -30.29±6.96** 肝功能C级 5 129.70±25.76* 83.55±20.94 676.50±79.13**# -44.62±9.24**## F — 6.65 3.32 8.55 36.31 P — < 0.01 < 0.05 < 0.01 < 0.01 MS组内 — 377.408 266.465 38 143.816 48.738 无乳腺发育症组 肝功能A级 34 22.18±4.58△△ 9.15±2.72△△ 1 046.51±275.39 -14.97±5.99 肝功能B级 32 23.76±4.75▲▲ 9.93±3.08▲▲ 874.14±162.60** -29.39±7.35** 肝功能C级 4 25.20±5.33▽▽ 9.98±2.95▽▽ 663.28±83.41** -41.06±6.23**## F — 1.37 0.64 8.30 54.09 P — >0.05 >0.05 < 0.01 < 0.01 MS组内 — 22.043 8.422 49 898.235 44.405 q检验:与肝功能A级比较*P < 0.05,**P < 0.01;与肝功能B级比较#P < 0.05,##P < 0.01。与乳腺发育症组肝功能A级比较△△P < 0.01;与乳腺发育症组肝功能B级比较▲▲P < 0.01;与乳腺发育症组肝功能C级比较▽▽P < 0.01 表 4 乳腺发育症组病人影像学指标与肝功能分级的相关性(r)
指标 Child-Pugh分级 涂氏肝硬化CT分级 V乳腺 0.592** 0.588** R乳/表 0.804** 0.794** V病肝 -0.871** -0.861** R肝 -0.895** -0.878** **P < 0.01 -
[1] 汪维艳, 杨京, 陆爽, 等. 男性肝硬化患者乳腺发育症与血清性激素及肝功能的相关性[J]. 中华消化杂志, 2015, 35(11): 734. doi: 10.3760/cma.j.issn.0254-1432.2015.11.004 [2] 贺科文, 刘兆芸, 于志勇. 男性乳腺癌与男性乳房发育症的鉴别及相关研究进展[J]. 中国肿瘤外科杂志, 2016, 8(3): 163. doi: 10.3969/j.issn.1674-4136.2016.03.005 [3] 黎一鸣, 吕凡, 吉鸿, 等. 肝脏体积变化与病肝储备功能的关系研究[J]. 中华普通外科杂志, 2003, 18(2): 79. doi: 10.3760/j.issn:1007-631X.2003.02.005 [4] 赵首捷, 杨振宇, 雷世雄, 等. Child-Pugh评分和ALBI分级对BCLC-B期肝癌生存预后预测价值比较[J/CD]. 中华肝脏外科手术学电子杂志, 2021, 10(1): 38. [5] 涂蓉, 张阳德, 伍保忠, 等. 肝硬化CT分级方法研究[J]. 放射学实践, 2003, 18(9): 621. doi: 10.3969/j.issn.1000-0313.2003.09.001 [6] FAGERLUND A, LEWIN R, RUFOLO G, et al. Gynecomastia: a systematic review[J]. J Plast Surg Hand Surg, 2015, 9(7): 1. [7] WU FC, TAJAR A, PYE SR, et al. Hypothalamic- pituitary- testicularaxis disruptions in older men are differentially linked to age and modifiable risk factors: the european male aging study[J]. J Clin Endocrinol Metab, 2008, 93(7): 2737. doi: 10.1210/jc.2007-1972 [8] 张爱玲, 秦贵军, 孟海阳, 等. 药源性男性乳腺发育症研究进展[J]. 药物不良反应杂志, 2015, 17(5): 357. [9] 韩景健, 晏文华. 男性乳腺发育症的病因及发病机制研究进展[J]. 中国美容整形外科杂志, 2020, 31(2): 89. doi: 10.3969/j.issn.1673-7040.2020.02.009 [10] 叶敏, 张爱霞, 王爱琳, 等. 男性乳腺发育症患者诊疗期间心理体验的质性研究[J]. 国际护理学杂志, 2016, 35(19): 2686. doi: 10.3760/cma.j.issn.1673-4351.2016.19.033 [11] 岳春燕. 肝硬化患者并发肝掌、蜘蛛痣的相关因素分析[J]. 中华现代护理杂志, 2019, 25(20): 2604. doi: 10.3760/cma.j.issn.1674-2907.2019.20.022 [12] 曾艳妮, 韩军, 刘良进, 等. 不同Child-Pugh分级的血吸虫病性肝硬化患者肝脏CT灌注成像参数分析[J]. 实用肝脏病杂志, 2020, 23(5): 691. doi: 10.3969/j.issn.1672-5069.2020.05.022 [13] 秦凌云. 正常老年人肝脏CT与年龄变化的相关性研究[D]. 南宁: 广西医科大学, 2012. [14] 杨伟. 高频超声应用于男性乳腺发育症的诊断价值与临床应用[J/CD]. 临床医药文献电子杂志, 2020, 7(17): 171. [15] 刘淑香. CT在男性乳腺发育症筛查中的应用价值[J]. 陕西医学杂志, 2017, 46(5): 629. doi: 10.3969/j.issn.1000-7377.2017.05.036 [16] 黄琰, 肖勤, 孙轶群, 等. 乳腺MRI鉴别诊断男性乳腺良恶性病变的价值[J]. 中华放射学杂志, 2021, 55(1): 48.