定量CT测量身体组分在肝硬化门静脉高压并发症中的应用价值  

Application of quantitative CT to measure body components in cirrhosis with portal hypertension complications

作　　者：刘田田 陈其春[1,2] 吴旱秋 詹昊 宫希军 LIU Tian-tian;CHEN Qi-chun;WU Han-qiu(Department of Radiology,the Second Hospital of Anhui Medical University,230601 Hefei,China)

机构地区：[1]安徽医科大学第二附属医院放射科,合肥230601 [2]安徽医科大学医学影像研究中心,合肥230601

出　　处：《放射学实践》2024年第7期913-918,共6页Radiologic Practice

基　　金：中国红十字基金会2022年医学赋能-领航菁英科研项目专项基金(XM_LHJY2022_05_07);2020年安徽医科大学校临床科研基金项目(2020xkj193)。

摘　　要：目的:基于定量CT(QCT)探讨肝硬化患者身体组分定量指标与门静脉高压并发症的相关性及其应用价值。方法:纳入2021年11月-2023年2月于本院就诊的134例肝硬化患者,受试者均行腹部CT平扫,收集临床资料并用QCT Pro软件测量每例受试者L2/3层面皮下及内脏脂肪面积(SAT、VAT)、腰椎骨密度(BMD)、肝脏脂肪分数(Fat%-QCT)、L3椎体水平全腹肌和椎旁肌面积(SMA、PMA)及肌内脂肪面积并计算肌内脂肪含量(IMAC-S、IMAC-P)。在不同Child-Pugh分级中进行组间资料对比,并根据有无门静脉高压并发症将患者分为两组比较身体组分差异,Mann-Whitney U检验或Kruskal-Wallis H检验、t检验或单因素ANOVA检验、χ^(2)检验用于各组间基本资料与身体组分的差异性分析;采用二元Logistic回归分析与肝硬化门静脉高压并发症相关的QCT指标,采用受试者操作特征(ROC)曲线分析不同模型的识别效能。结果:Fat%-QCT、SAT、椎旁肌内脂肪面积、IMAC-P在不同Child-Pugh分级中差异有统计学意义(P<0.05);多因素Logistic回归分析显示SAT是肝硬化门静脉高压并发症的独立相关因素(P<0.05,OR为0.987);SAT、SAT联合全腹肌指标、SAT联合椎旁肌指标的ROC曲线下面积(AUC)分别为0.727、0.772、0.769(P<0.05),SAT联合全腹肌指标的敏感度及特异度分别为0.734、0.800,优于SAT、SAT联合椎旁肌指标,识别效能最高。结论:SAT减少是肝硬化门静脉高压并发症风险增加的独立危险因素,SAT联合全腹肌指标能较好地识别肝硬化门静脉高压并发症。Objective:To explore the correlation between quantitative indexes of body components based on quantitative CT(QCT) and portal hypertension complications in cirrhosis.Methods:The study included 134 patients with cirrhosis from our hospital between November 2021 and February 2023.All patients underwent abdominal CT scan,and clinical data were collected and measured with QCT Pro software for subcutaneous and visceral adipose tissue(SAT,VAT),lumbar vertebral bone mineral density(BMD),hepatic fat fraction(Fat%-QCT),total abdominal skeletal muscle area,and paraspinal muscle area(SMA,PMA),and intramuscular adipose tissue area.The intramuscular adipose tissue content of skeletal muscle and paraspinal muscle(IMAC-S,IMAC-P) were calculated.Data were compared in different Child-Pugh grades and the presence or absence of portal hypertension complications.The Mann-Whitney U test or Kruskal-Wallis H test,t-test or one-way ANOVA test and χ^(2) test were used for difference analysis of basic data and body components between groups.The QCT indicators associated with complications of portal hypertension in cirrhosis were analyzed using binary logistic regression,and the identifying efficacy of the different models was tested using receiver operating characteristic(ROC) curves.Results:Fat%-QCT,SAT,paraspinal intramuscular adipose tissue area,and IMAC-P differed significantly across Child-Pugh grade(P<0.05);Multivariate logistic regression analysis revealed that SAT was an independent associated factor for portal hypertension complications in cirrhosis(P<0.05,OR:0.987).The area under the ROC curve(AUC) of SAT,SAT combined with total abdominal skeletal muscle index,and SAT combined with paraspinal muscle index were 0.727,0.772,and 0.769(P<0.05),respectively.The sensitivity and specificity of SAT combined with total abdominal skeletal muscle index were 0.734 and 0.800,respectively,which were superior to that of SAT,and SAT combined with paraspinal muscle index and had the highest recognition efficacy.Conclusion:Decreased SAT is an in

关 键 词：肝硬化 门静脉高压 并发症 身体组分 定量CT 

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