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

摘要

目的:探讨低位梗阻性黄疸超高场强MRCP表现与中医黄疸分型的关系,寻求中医临床辨证分型的可视性依据.方法:回顾性分析70例低位梗阻性黄疸患者的MRCP图像,并由高年资中医医师对其辨证分型,分为阳黄和阴黄.阳黄主证黄疸黄色鲜明,伴身热,口苦,苔黄腻,脉弦数.阴黄主证黄疸黄色晦暗,伴纳少,乏力,舌淡,脉沉缓无力.在3D-MRCP图像上测量胆总管扩张的宽径,并对梗阻的影像征象进行分型.采用校正χ2检验和Fisher精确法比较阳黄、阴黄在胆管扩张程度与影像征象改变方面的差异,以P<0.05为差异有统计学意义.结果:70例中阳黄50例,阴黄20例.阳黄和阴黄在肝外胆管扩张程度上差异有统计学意义,阳黄以轻度和中度多见,阴黄以重度多见.倒杯口征和鼠尾征与阳黄关系密切,双管征、四管征、截断征与阴黄关系密切.阳黄以胆管结石和胆管炎为主,阴黄以肿瘤为主.结论:超高场强MRCP图像质量高,黄疸患者肝外胰胆管扩张程度等与中医黄疸分型存在一定相关性.%Objective:To seek clinical medicine dialectical type visibility basis by exploring the relationship between the ul-tra-high field strength MRCP diagnosis of pancreatic duct water and Chinese medicine jaundice classification. Methods:MRCP was analyzed in 70 patients with low-level obstructive jaundice. According to TCM theory and dialectical classification by senior Chinese medicine practitioners,patients were divided into Yang Huang and Yin Huang. Yang Huang main Yellow bright,with heat,mouth bitter,yellow greasy fur,wiry pulse. Yin yellow main Yellow faint,with less satisfied,weak,pale tongue,deep pulse. The width of the common bile duct dilatation was measured on the 3D-MRCP image,and the signs of obstruction were typed. The difference was compared between Yang Huang and Yin Huang in the bile dilation and imaging signs by using chi-square analysis and Fisher exact correction method. The difference was statistically significant with P<0.05. Results:There were 50 cases of Yang Huang and 20 cases of Yin Huang. Between Yang Huang and Yin Huang,there was significant difference in the extrahepatic bile duct expansion degree. Yang Huang to mild and moderate degree was more common,while Yin Huang to sev-er degree. The image signs of "inverted cup levy","rat-tail sign" had close relationship with Yang Huang. "Double duct sign","four-segment sign" and "cut off sign" were closely related with Yin Huang. Yang Huang was mainly bile duct stones and cholangitis,and Yin Huang was mainly tumors. Conclusion:Ultra-high field strength MRCP can get high-quality images. The ex-tent of extrahepatic cholangiopancreatodilatation and its image changes in patients with jaundice are related to the classification of jaundice in traditional Chinese medicine.