多层螺旋CT门静脉造影评估肝硬化病变程度及预测肝性脑病发病风险的价值  

The value of multi-slice spiral computed tomography portography in assessing severity of liver cirrhosis and predicting episode risks of hepatic encephalopathy

作　　者：刘文娜[1] 王剑[2] 冯义朝[1] 戴光荣[1] 宁涛[3] 

机构地区：[1]延安大学附属医院消化科二病区,716000 [2]延安大学附属医院CT室,716000 [3]延安大学附属医院普外科二病区,716000

出　　处：《中华肝脏病杂志》2014年第7期509-513,共5页Chinese Journal of Hepatology

基　　金：延安大学附属医院研究生创新基金项目（10YJ11）

摘　　要：目的 探讨多层螺旋CT门静脉造影（MSCTP）评估肝硬化病变程度及预测肝性脑病（HE）发病风险的临床应用价值.方法 收集延安大学附属医院消化科住院的86例肝硬化患者,均行64层螺旋CT门静脉造影,分析门静脉系统病变与Child-Pugh分级和HE分级之间的关系,探讨肝硬化MSCTP分级与Child-Pugh分级的相关性,并尝试应用MSCTP预测HE的发病风险.计量资料多组间均数比较用单因素方差分析,两组间比较采用Mann-Whitney U检验,等级资料比较用秩和检验;计数资料采用x2检验;相关性用Spearman相关分析.结果 HEⅢ级与Ⅰ级比较,胃左静脉、脾静脉、肝内门静脉左支及肝内门静脉右支的直径差异均有统计学意义（P值均＜0.05）.Child-Pugh C级与A级相比,胃左静脉、脾静脉、肝内门静脉左支及肝内门静脉右支直径差异均有统计学意义（P值均＜ 0.05）;不同Child-Pugh分级和HE分级患者的门静脉主干直径差异无统计学意义（P值均＞ 0.05）.不同HE分级的肝硬化患者,门静脉栓子形成率和肝动脉-门静脉瘘形成率差异均有统计学意义（P值均＜ 0.05）,且HE分级与门静脉栓子形成和肝动脉-门静脉瘘形成分别具有一定的相关性（r值分别为0.687和0.565,P值均＜0.05）.肝硬化MSCTP分级（一级35例,二级36例,三级15例）和Child-Pugh分级（A级36例,B级32例,C级18例）差异无统计学意义（Z=-0.135,P＞0.05）.MSCTP分级为一、二、三级的肝硬化患者中,HE发病率分别为0（0）、33.3％ （12/36）、66.7％ （10/15）,差异有统计学意义（x2=26.468,P＜0.05）.相关分析结果显示,肝硬化MSCTP分级与HE发病具有一定的相关性（r=0.552,P＜0.05）. 结论 MSCTP对肝硬化病变程度有较高的评估价值,对HE的发病风险具有一定的预测价值,但仍需加大样本量进一步验证.Objective To explore the clinical value of multi-slice spiral computed tomography portography （MSCTP） in assessing severity of liver cirrhosis and predicting episode risks of hepatic encephalopathy （HE）.Methods Eighty-six patients with liver cirrhosis who were hospitalized in the Department of Gastroenterology at the Affiliated Hospital of Yan＇an University were included in the study.All patients underwent 64-slice MSCTP to grade the portal vein anatomy.The West Haven criteria were used for semi-quantitative assessment of each patient＇s mental state.The Child-Pugh grading system was used to assess the extent of cirrhosis.Comparison of measurement data between multiple groups was made by one-way ANOVA analysis,and comparison of such between two groups was made by the Mann-Whitney U test,Ranked data were compared with the rank-sum test,and count data were compared by the Chi-Square test.Correlation analysis was performed with Spearman＇s correlation test.Results Comparison of the HE grade Ⅲ group and the HE grade Ⅰ group showed significant differences between the two in the diameters of left gastric vein,the splenic vein,the intrahepatic left portal vein and the intrahepatic right portal vein （P 〈 0.05）.Comparison of the Child-Pugh grade C group and the Child-Pugh grade A group showed significant differences between the two in diameters of the left gastric vein,the splenic vein,the intrahepatic left portal vein and the intrahepatic right portal vein （P 〈 0.05）.The diameters of the main portal vein were not significantly different between the ChildPugh grades and HE classifications （P 〉 0.05）.The results of MSCTP did show significant differences between different HE classifications in patients with liver cirrhosis and the rate of formation of portal vein thrombosis and fistulas of the hepatic artery-portal vein （P 〈 0.05）,.but no significant differences with the esophageal and gastric varices,varicose veins around the esophagus,and periumbilical varicose veins （P 〉 0.05�

关 键 词：肝硬化 肝性脑病 体层摄影术 螺旋计算机 

分 类 号：R575[医药卫生—消化系统]