老年肝癌自发性破裂出血MSCT影像学特征及预后风险因素分析  

MSCT Imaging Features and Prognostic Risk Factors of Spontaneous Rupture Hemorrhage in Elderly Hepatocellular Carcinoma

作　　者：王久臣 陈华东 WANG Jiu-chen;CHEN Hua-dong*(Enshi Tujia and Miao Autonomous Prefecture Central Hospital,Enshi 445000,Hubei Province,China)

机构地区：[1]恩施土家族苗族自治州中心医院,湖北恩施445000

出　　处：《中国CT和MRI杂志》2024年第12期106-109,共4页Chinese Journal of CT and MRI

摘　　要：目的分析老年肝癌自发性破裂出血(SRHC)多层螺旋计算机断层扫描(MSCT)影像学特征,并分析影响SRHC患者预后风险因素。方法回顾2018年3月至2021年2月我院收治的42例老年SRHC患者(出血组)及同期年龄、性别等基线资料匹配的84例肝癌无自发性出血患者(未出血组)的临床资料。对比两组患者的MSCT影像学特征,随访统计出血组与未出血组患者预后生存情况,采用Cox比例风险回归分析影响老年肝癌患者预后总生存期的相关因素。结果出血组甲胎蛋白(AFP)>400μg/L、肝功能B级患者占比高于未出血组,差异有统计学意义(P<0.05);出血组患者肿瘤最大径≥10cm、肿瘤跨叶分布、弓弦比>1、膈肌侵犯、肝硬化、肿瘤外凸占比≥25%、有门静脉阻塞患者的占比高于未出血组,差异有统计学意义(P<0.05)。出血组与未出血组患者平均生存时间为(16.48±2.04)个月、(25.06±1.39)个月,出血组与未出血组患者1年、3年总体生存率分别为71.4%、20.4%和85.7%、46.2%,Kaplan-Meier生存分析显示,出血组与未出血组累积生存率比较,差异有统计学意义(Log Rankχ^(2)=12.822,P<0.001)。多因素Cox回归分析显示,AFP>400μg/L、肿瘤最大径≥10cm、微血管侵犯、自发性破裂出血是影响老年肝癌患者总生存期的独立风险因素(P<0.05)。结论MSCT多种影像学特征与老年肝癌患者发生自发性破裂出血密切相关,且自发性破裂出血是影响老年肝癌总体生存的独立风险因素。Objective To analyze the multilayer spiral computed tomography(MSCT)imaging features of spontaneous rupture hemorrhage(SRHC)in elderly patients with hepatocellular carcinoma and to analyze the risk factors affecting the prognosis of patients with SRHC.Methods The clinical data of 42 elderly patients with SRHC admitted to our hospital from March 2018 to February 2021(bleeding group)and 84 patients with hepatocellular carcinoma without spontaneous bleeding(non-bleeding group)matched for age and gender and other baseline information during the same period were reviewed.The MSCT imaging features of patients in the two groups were compared.The prognosis and survival of patients in the bleeding group and the non-bleeding group were followed up and counted.Cox proportional hazard regression was used to analyze the factors influencing the overall survival of elderly patients with liver cancer.Results The proportion of patients with alpha-fetoprotein(AFP)>400μg/L and liver function grade B was higher in the bleeding group than in the non-bleeding group(P<0.05).The proportion of patients with maximum tumour diameter≥10cm,tumour distribution across lobes,bowstring ratio>1,diaphragmatic invasion,cirrhosis,tumour ectasia accounting for≥25%,and patients with portal vein obstruction were higher in the bleeding group than in the nonbleeding group(P<0.05).The mean survival time for patients in the bleeding versus non-bleeding group was(16.48±2.04)months and(25.06±1.39)months.The overall survival rates of patients in the bleeding and non-bleeding groups at 1 year and 3 years were 71.4%,20.4%and 85.7%,46.2%,respectively.Kaplan-Meier survival analysis showed a statistically significant difference in cumulative survival between the bleeding and non-bleeding groups(Log Rankχ^(2)=12.822,P<0.001).Conclusion Multiple imaging features of MSCT are closely associated with the development of spontaneous rupture haemorrhage in elderly patients with liver cancer,and spontaneous rupture haemorrhage is an independent risk factor for over

关 键 词：自发性破裂出血 肝癌 老年 多层螺旋计算机断层扫描 影像学特征 预后 

分 类 号：R735.7[医药卫生—肿瘤]