肝胆影像学指标对乙肝后肝硬化门静脉高压症患者肝功能预测价值  

Predictive value of hepatobiliary imaging indexes for liver function in patients with portal hypertension due to post-hepatitis B cirrhosis

作　　者：胡竞雄 周静[2] 黄茜 马瑞颖 彭文广 钟跃思[1] Hu Jingxiong;Zhou Jing;Huang Qian;Ma Ruiying;Peng Wenguang;Zhong Yuesi(Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;School of Statistics,Renmin University of China,Beijing 100872,China;Department of Infectious Diseases,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630 [2]中国人民大学统计学院,北京100872 [3]中山大学附属第三医院感染科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2021年第5期493-497,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(81470680)。

摘　　要：目的探讨肝胆影像学指标对乙型病毒性肝炎(乙肝)后肝硬化门静脉高压症患者肝功能的预测价值。方法回顾性分析2012年1月至2018年12月在中山大学附属第三医院诊治的429例乙肝后肝硬化门静脉高压症患者临床资料。其中男382例,女47例;平均年龄(52±11)岁。患者签署知情同意书,符合医学伦理学规定。采用CT或MRI检查测量胆囊壁厚度、胆囊截面积、脾脏截面积及肝右叶厚度。肝功能评估采用Child-Pugh评分和ICGR15。采用多因素线性回归建立Child-Pugh评分预测模型,以R2和均方根误差(RMSE)评估预测模型。采用Logistic回归分析建立ICGR15预测模型,ROC曲线评估预测模型。结果胆囊壁厚度、胆囊截面积与右肝厚度的比值与Child-Pugh评分相关,预测模型方程为Child-Pugh评分=4.841+0.177X1+0.175X2,其中X1为胆囊壁厚度,X2为胆囊截面积/右肝厚度的值;R2值为0.6002,RMSE为0.539。右肝厚度、胆囊壁厚度和脾脏截面积与ICGR15相关,预测模型为P(Y=1|X)=exp(3.032-0.672X1+0.477X2+0.017X3)1+exp(3.032-0.672X1+0.477X2+0.017X3),其中X1为右肝厚度,X2为胆囊壁厚度,X3为脾脏截面积;模型ROC曲线下面积为0.814,敏感度、特异度分别为0.86、0.63。结论肝胆影像学指标作为无创检查指标,能较准确地预测乙肝后肝硬化门静脉高压症患者肝功能。Objective To evaluate hepatobiliary imaging indexes in predicting liver function in patients with portal hypertension due to post-hepatitis B cirrhosis.Methods Clinical data of 429 patients with portal hypertension due to post-hepatitis B cirrhosis admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2018 were retrospectively analyzed.Among them,382 patients were male and 47 female,aged(52±11)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.The thickness of gallbladder wall,the cross-sectional area of gallbladder,cross-sectional area of spleen and thickness of right liver lobe were quantitatively measured by CT scan or MRI.Liver function was evaluated by Child-Pugh score and ICGR15.Child-Pugh prediction model was established by multivariate linear regression analysis,and evaluated by R2 and root-mean-square error(RMSE).ICGR15 prediction model was established by Logistic regression analysis and evaluated by the ROC curve.Results The thickness of gallbladder wall and the ratio of cross-sectional area of gallbladder to thickness of right liver lobe were related to the Child-Pugh score.The equation of prediction model:Child-Pugh score=4.841+0.177X1+0.175X2,X1 is the thickness of gallbladder wall,X2 is the ratio of cross-sectional area of gallbladder to thickness of right liver lobe.The R2 value was 0.6002 and RMSE was 0.539.The thickness of right liver lobe,thickness of gallbladder wall,and cross-sectional area of spleen were related to ICGR15.The prediction model:P(Y=1|X)=exp(3.032-0.672X1+0.477X2+0.017X3)1+exp(3.032-0.672X1+0.477X2+0.017X3),X1 is thickness of right liver lobe,X2 is thickness of gallbladder wall and X3 is cross-sectional area of spleen.The area under the ROC curve(AUC)of the prediction model was 0.814,and the sensitivity was 0.86 and the specificity was 0.63.Conclusions As non-invasive indexes,hepatobiliary imaging indexes can relatively accurately predict the liver function of pat

关 键 词：高血压 门静脉 影像学指标 CHILD-PUGH评分 ICGR15 肝功能试验 预测 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]