基于CT肝细胞外体积分数对门静脉高压症术后再出血的预测价值  

CT-based hepatic extracellular volume fraction in the prediction of postoperative rebleeding in portal hypertension

作　　者：杨鑫 王文剑 傅剑雄[1] 孙骏[1] 叶靖[1] 蒋国庆[1] 罗先富 YANG Xin;WANG Wen-jian;FU Jian-xiong(Department of Medical Imaging,Northern Jiangsu People's Hospital,Jiangsu 225001,China)

机构地区：[1]扬州大学临床医学院江苏省苏北人民医院,江苏扬州225001 [2]大连医科大学,辽宁大连116044

出　　处：《放射学实践》2024年第7期907-912,共6页Radiologic Practice

摘　　要：目的:探讨CT肝细胞外体积分数(ECV)预测肝硬化门静脉高压症术后胃底食管静脉再出血(EGVR)的价值。方法:回顾性分析154例门静脉高压患者行经腹腔镜脾切除联合贲门周围血管离断术(LSD)的患者术前CT图像及实验室检查资料。经过术后一年的随访,将患者分为再出血组和非再出血组。选取平扫及延迟期图像,分别测量肝脏、脾脏及主动脉的增强前后CT值,计算肝脏及脾脏细胞外体积分数(ECV)。比较ECV在再出血与非再出血组之间差异。通过多因素分析筛选再出血相关危险因素。构建ECV及联合参数模型,使用受试者操作特征曲线下面积(AUC)评估构建模型的预测效能。结果:LSD术后再出血组肝脏ECV值显著低于非再出血组(32.0%±4.5%vs.39.9%±4.0%,P<0.0001)。再出血组脾脏ECV低于非再出血组(42.1%±7.5%vs.46.2%±6.8%,P=0.002)。凝血酶原时间(PT)、纤维蛋白原(FIB)、肝脏ECV是患者发生术后再出血的独立危险因素,其再出血的诊断效能AUC值分别为0.711、0.724、0.923。联合模型(PT+FIB+肝脏ECV)的AUC值为0.963,与单独肝脏ECV模型差异无统计学意义。结论:肝脏ECV能有效预测门静脉高压患者LSD术后再出血的发生,优于PT和FIB的诊断效能。Objective:To investigate the feasibility of hepatic extracellular volume fraction(ECV) to predict postoperative esophagogastric variceal re-bleeding(EGVR) in patients with cirrhotic portal hypertension based on contrast-enhanced CT(CECT) images.Methods:A total of 154 patients who underwent laparoscopic splenectomy and azygoportal disconnection(LSD) were retrospectively analyzed.The patients were divided into re-bleeding and non-rebleeding groups based on one year of postoperative follow-up.Abdominal plain CT and delayed-phase images were selected,and the plain CT values and enhanced CT values of the liver,spleen,and aorta were measured.Hepatic ECV and spleen ECV were calculated,and the difference in ECV between the two groups was compared.Rebleeding-related risk factors were screened by multifactorial analysis.The area under the receiver operating characteristic curve(AUC) was used to evaluate the predictive performance of the ECV and combined models.Results:Hepatic ECV was significantly lower in the rebleeding group than in the non-rebleeding group(32.0%±4.5% vs.39.9%±4.0%,P<0.0001).Spleen ECV was lower in the rebleeding group than in the non-rebleeding group(42.1%±7.5% vs.46.2%±6.8%,P=0.002).Prothrombin time(PT),fibrinogen(FIB),and hepatic ECV were identified as independent risk factors for patients to develop postoperative rebleeding,and the AUC values were 0.711,0.724,and 0.923,respectively.The AUC value of combined hepatic ECV model was 0.963,with no statistical difference between single hepatic ECV.Conclusion:Hepatic ECV can effectively predict the occurrence of rebleeding after LSD in patients with portal hypertension and it is superior to PT and FIB laboratory parameters.

关 键 词：体层摄影术 X线计算机 肝硬化 细胞外体积分数 腹腔镜脾切除联合贲门周围血管离断术 食管胃底静脉再出血 

分 类 号：R814.42[医药卫生—影像医学与核医学] R571.3[医药卫生—放射医学] R575.2[医药卫生—临床医学]