多螺旋CT联合血清胆红素在上消化道急性穿孔的应用价值  

Application Value of Multislice CT Combined with Serum Bilirubin in Acute Upper Gastrointestinal Perforation

作　　者：张圆 王利顺 王启晨 张国梁 赵瑶瑶 胡一博 李建斌 ZHANG Yuan;WANG Li-shun;WANG Qi-chen(Department of Radiology,Maternity&Child Care Center of Qinhuangdao,Qinhuangdao 066000,Hebei Province,P.R.C.)

机构地区：[1]秦皇岛市妇幼保健院放射科,河北省066000

出　　处：《中国数字医学》2020年第8期130-132,147,共4页China Digital Medicine

摘　　要：目的:分析多螺旋CT联合血清胆红素在上消化道急性穿孔的应用价值。方法:选取2015年5月至2017年5月我院急诊收治的上消化道穿孔组及和无上消化道穿孔的作为对照组,另选取同期来我院体检的30例正常志愿者作为对照组,比较单纯胆红素、多螺旋CT及胆红素联合多螺旋CT诊断结果。结果:单纯诊断中总胆红素(TSB)诊断特异度高于CT检查(χ^2=5.93,P=0.012),而敏感度低于CT(χ^2=5.328,P=0.023),而TSB+CT(系列联合)检查敏感度为100.0%,明显高于其余诊断方法(χ^2=7.341、9.432、8.431,P=0.012、0.007、0.010),TSB+CT(平行联合)检查特异度为93.8%,明显高于其余诊断方法(χ^2=7.743、8.832、5.431,P=0.022、0.011、0.030);单纯TSB、CT检测、平行联合及系列联合ROC曲线下面积分别为0.761、0.763、0.915、0.904,平行联合检测ROC曲线下面积大于其余诊断方法的曲线下面积(χ^2=7.124、7.032、6.421,P=0.022、0.028、0.030),而系列联合诊断曲线面积明显高于单纯TSB及CT诊断(χ^2=6.682、6.214,P=0.032、0.042),具有统计学意义。结论:多螺旋CT联合血清胆红素(平行联合)能有效提高上消化道急性穿孔诊断的灵敏度,多螺旋CT联合血清胆红素(系列联合)能有效提高上消化道急性穿孔诊断的特异度,对于上消化道穿孔的早期诊断具有重要价值。Objective:To analyze the application value of multislice CT combined with serum bilirubin in acute upper gastrointestinal perforation.Methods:The patients of the upper gastrointestinal perforation group and the group without upper gastrointestinal perforation received by our hospital from May 2015 to May 2017 are selected as the control group,and 30 normal volunteers who come to our hospital for physical examination in the same period are selected as the control group.The diagnostic results of bilirubin alone and multislice CT combined with bilirubin are compared.Results:In the simple diagnosis,the specificity of TSB diagnosis is higher than that of CT(χ^2=5.93,P=0.012),but the sensitivity is lower than that of CT(χ^2=5.328,P=0.023).The sensitivity of TSB+CT(series combination)examination is100.0%,which is significantly higher than that of other diagnosis methods(χ^2=7.341,9.432,8.431,P=0.012,0.007,0.010).The specificity of TSB+CT(parallel combination)examination is 93.8%,which is significantly higher than that of other diagnosis methods(χ^2=7.743,8.832,5.431,P=0.022,0.011,0.030).The ROC curve of each diagnosis method of upper gastrointestinal perforation is shown in Figure1.The area under the ROC curve of TSB alone,CT testing,parallel combination and series combination is 0.761,0.763,0.915 and 0.904,respectively.The area under the ROC curve of parallel combined detection is bigger than that of other diagnosis methods(χ^2=7.124,7.032,6.421,P=0.022,0.028,0.030).The curve area of series of combined diagnosis is significantly bigger than that of TSB and CT diagnosis alone(χ^2=6.682,6.214,P=0.032,0.042)and has statistical significance.Conclusion:The multislice CT combined with serum bilirubin(parallel combination)can effectively improve the sensitivity of diagnosis of acute upper gastrointestinal perforation,while multislice CT combined with serum bilirubin(series combination)can effectively improve the specificity of diagnosis of acute upper gastrointestinal perforation,which has important value for the early

关 键 词：多螺旋CT 血清胆红素 上消化道急性穿孔 诊断 

分 类 号：R319[医药卫生—基础医学] R445.3