术前胆汁CT值测定诊断胆囊泥沙样结石的应用价值分析  

Diagnostic performanceof preoperative bile CT value in patients with gallbladder muddy stones

作　　者：韩文有 李向军[1] 赵森峰 徐俊梅 刘博[1] Han Wenyou;Li Xiangjun;Zhao Senfeng(Department of Hepatobiliary Surgery,First Medical Center of PLA,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆外科,北京市100853 [2]内蒙古自治区包头市九原区医院

出　　处：《实用肝脏病杂志》2021年第3期443-446,共4页Journal of Practical Hepatology

摘　　要：目的探讨术前胆汁CT值测定在胆囊泥沙样结石诊断中的应用价值。方法2018年9月~2020年9月解放军总医院肝胆外科常规检查假阴性的胆囊泥沙样结石患者72例和同期因肝脏手术切除正常胆囊的患者40例,常规检查腹部CT并测量CT值,比较两组血白细胞、血淀粉酶、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷酰转肽酶(GGT)、白细胞介素-6(IL-6)、降钙素原(PCT)和C反应蛋白(CRP)水平。应用受试者工作特征曲线下面积(AUC)分析CT值诊断的效能。结果两组肝功能和血象变化无显著性差异(P>0.05);胆囊结石患者胆汁CT值为(66.01±18.24)Hu,显著高于对照组患者【(25.40±8.23)Hu,P<0.05】;两组术后血清炎症因子水平比较,也无显著性差异(P>0.05);受试者工作特征曲线(ROC)分析显示,以胆汁CT值>25.60 Hu为截断点,其诊断胆囊泥沙样结石的曲线下面积(AUC)为0.954,灵敏性为92.3%,特异性91.0%。结论常规影像学检查假阴性的胆囊泥沙样结石患者胆汁CT值显著高于正常胆囊者,结合临床表现和胆汁CT值可以诊断胆囊泥沙样结石,值得进一步研究。Objective The aim of this study was to investigate the application of preoperative bile CT value in the diagnosis of patients with gallbladder muddy stones.Methods 72 patients with routine imaging false-negative gallbladder muddy stones and 40 patients undergoing gallbladder excision due to liver surgery were enrolled in Hepatobiliary Surgery of PLA General Hospital between September 2018 and September 2020,and all patients underwent abdominal CT scan.Serum interleukin-6(IL-6),procalcitonin(PCT),and C-reactive protein(CRP)levels were obtained.The area under the receiver operating characteristic curve(AUC)was applied to predict the diagnostic value.Results There were no significant differences in changes of liver function tests and blood parameters between the two groups(P>0.05);the bile CT value in gallbladder stone group was significantly higher than that in control group[(66.01±18.24)Hu vs.(25.40±8.23)Hu,P<0.05];there was no significant differences as respect to serum cytokines and PCT levels;the ROC curves analysis showed that the AUC,sensitivity and specificity were 0.954,92.3%and 91.0%,respectively as the bile CT value greater than 25.60 Hu was set as the cut-off-value for the diagnosis of gallbladder muddy stones.Conclusion The imaging examination shows that bile CT value in patients with false-negative gallbladder muddy stones is significantly higher than that in the subjects with normal gallbladder without stone.The accuracy of bile CT value is relatively higher in the diagnosis of gallbladder muddy stones.

关 键 词：胆囊结石 泥沙样结石 胆汁 计算机体层成像 诊断 

分 类 号：R657.42[医药卫生—外科学]