基于DECT的碘斜率无创评估肝硬化患者肝功能的相关研究  

A Study of DECT-based Non-invasive Assessment of Liver Function by Iodine Slope in Patients with Cirrhosis

作　　者：韩磊 苏宁[2] 刘晓林[2] 邬超 HAN Lei;SU Ning;LIU Xiaolin;WU Chao(Affiliated Baotou Clinical College of Inner Mongolia Medical University,Baotou 014040,Inner Mongolia Autonomours Region,P.R.China;Imaging Center of Baotou Central Hospital,Baotou 014040,Inner Mongolia Autonomours Region,P.R.China)

机构地区：[1]内蒙古医科大学包头临床医学院,内蒙古包头014040 [2]包头市中心医院影像中心,内蒙古包头014040

出　　处：《影像科学与光化学》2024年第2期160-166,共7页Imaging Science and Photochemistry

基　　金：内蒙古自治区重点研发和成果转化计划项目(2022YFSH0076);包头市医药卫生健康科技计划项目(wsjkwkj035);包头医学院创新团队发展计划项目(byjj-zxtd-003)。

摘　　要：目的:探究碘斜率无创评估肝硬化患者肝功能分级的相关研究,确定碘斜率在肝硬化患者中的应用价值。方法:前瞻性收集包头市中心医院2022年5月至2023年6月期间行腹部双能量CT(DECT)患者,筛选经临床/病理诊断为肝硬化患者59例(ALBI 1、2、3级分别27例、23例、9例),同时选取健康对照患者15例,收集所有入组对象基线资料。通过DECT扫描的动脉期、门脉期、延时期获取碘值以及各期相间隔时间计算碘斜率,采用白蛋白-胆红素评分(ALBI)进行肝功能分级。使用Spearman相关系数分析碘斜率与ALBI之间的相关性;使用单因素方差分析及非参数K-W检验比较组间碘斜率的差异性;使用受试者操作特征(ROC)曲线评估碘斜率鉴别不同肝功能分组的诊断效能,并计算其截断值、敏感度、特异度以及ROC曲线下面积(AUC)。结果:λ1、λ2与ALBI分级(r=-0.82,P<0.01;r=-0.66,P<0.01)间均存在显著负相关;λ1在对照组、肝硬化组ALBI分级各组间差异均有统计学意义(P<0.001),λ2在对照组和肝硬化组间差异具有统计学意义(P<0.001);λ1鉴别对照组vs. ALBI 1级、ALBI 1级vs. ALBI 2级、ALBI 2级vs. ALBI 3级的AUC为0.80、0.86、0.96;λ2鉴别对照组vs. ALBI 1级、ALBI 1级vs. ALBI 2级、ALBI 2级vs. ALBI 3级的AUC为0.64、0.78、0.76。结论:基于DECT的碘斜率与ALBI有显著相关性,能够作为评估肝硬化患者肝功能的可靠指标,且随着肝硬化的加重,评估效能也逐渐提高,具有一定的临床应用价值。Objective:To explore the correlation of iodine slope in non-invasive evaluation of liver function grade in patients with cirrhosis,and to determine the application value of iodine slope in patients with cirrhosis.Methods:From May 2022 to March 2023,patients undergoing abdominal DECT in our hospital were prospectively collected,59 patients with cirrhosis clinically/pathologically diagnosed(27,23,9 cases of ALBI 1,2,and 3,respectively)were screened,and 15 healthy control patients were selected,and baseline data of all enrolled subjects were collected.The iodine value was obtained by the arterial phase,portal phase and extended phase of DECT scanning,and the iodine slope was calculated by the interval time of each phase,and the liver function was graded by albumin-bilirubin score(ALBI).Spearman correlation coefficient was used to analyze the correlation between iodine slope and ALBI.Univariate analysis of variance and non-parametric K-W test were used to compare the difference of iodine slope between groups.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic effectiveness of iodine slope in identifying different liver function groups.The cut-off value,sensitivity,specificity and area under the curve(AUC)were calculated.Results:There were significant negative correlations betweenλ1,λ2 and ALBI classification(r=-0.82,P<0.01,r=-0.66,P<0.01).λ1 in the control group and the cirrhosis group ALBI grade difference was statistically significant(P<0.001),λ2 in the control group and the cirrhosis group difference was statistically significant(P<0.001).The AUC of the control group vs.ALBI 1,ALBI 1 vs.ALBI 2,ALBI 2 vs.ALBI 3 was 0.80,0.86,0.96.λ2 identified the AUC of control group vs.ALBI 1,ALBI 1 vs.ALBI 2,ALBI 2 vs.ALBI 3 as 0.64,0.78,0.76.Conclusion:Iodine slope based on DECT is significantly correlated with ALBI,and can be used as a reliable indicator to evaluate liver function in patients with cirrhosis.With the aggravation of cirrhosis,the evaluation efficiency is gradually improved,whic

关 键 词：DECT 碘斜率 肝硬化 白蛋白-胆红素评分 准确性 

分 类 号：R575.2[医药卫生—消化系统] R816.5[医药卫生—内科学]