能谱CT多定量参数结合临床特征对肝硬化高危食管胃静脉曲张的预测价值  

Predictive value of spectral CT multi-quantitative parameters combined with clinical characteristics on high-risk gastroesophageal varices of liver cirrhosis

作　　者：黄瑞岁 覃雯祺 丁可 陆善金 林彬 黄建宁 苏娟 HUANG Ruisui;QIN Wenqi;DING Ke;LU Shanjin;LIN Bin;HUANG Jianning;SU Juan(Department of Radiology,the Third Affiliated Hospitalof Guangxi Medical University,Nanning 530031,China)

机构地区：[1]广西医科大学第三附属医院放射科,广西南宁530031

出　　处：《实用放射学杂志》2025年第2期236-240,共5页Journal of Practical Radiology

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20221139)。

摘　　要：目的探讨能谱CT多定量参数结合临床特征在预测肝硬化患者高危食管胃静脉曲张(GOV)中的应用价值。方法回顾性分析112例确诊为肝硬化患者的上腹部能谱CT增强及电子胃镜检查结果,并收集其临床资料。根据患者胃镜下表现,分为高危GOV组(n=74)和低危GOV组(n=38)。单因素分析比较2组间的能谱CT定量参数及临床特征,多因素logistic回归分析筛选高危GOV的独立危险因素,应用R软件构建预测高危GOV的列线图模型,并对预测模型的区分度、校准度、临床实用性进行评估。结果肝左叶标准化碘浓度(NIC)、凝血酶原时间(PT)、白蛋白(ALB)及肝功能分级是高危GOV的独立危险因素(P<0.05),由此建立的列线图模型预测发生高危GOV的受试者工作特征(ROC)曲线的曲线下面积(AUC)为0.893。校准曲线显示预测结果与实际结果基本一致。决策曲线分析(DCA)显示预测模型具有良好的临床实用性。结论基于肝左叶NIC、PT、ALB及肝功能分级构建的列线图模型有助于预测肝硬化高危GOV的患者,为临床预防和治疗食管胃静脉曲张破裂出血(EVB)提供参考依据。Objective To investigate the application value of spectral CT multi-quantitative parameters combined with clinical characteristics in predicting high-risk gastroesophageal varices(GOV)in patients with liver cirrhosis.Methods The results of upper abdominal spectral CT enhancement and electronic gastroscopy in 112 patients diagnosed with liver cirrhosis were analyzed retrospec-tively,and the clinical data were collected.According to the gastroscopic manifestations,the patients were divided into high-risk GOV group(n=74)and low-risk GOV group(n=38).Univariate analysis was used to compare the spectral CT quantitative parameters and clinical characteristics between the two groups.Multivariate logistic regression analysis was used to screen the independent risk factors for high-risk GOV.R software was used to construct a nomogram model for predicting high-risk GOV,and the differentia-tion,calibration and clinical practicability of the prediction model were evaluated.Results The normalized iodine concentration(NIC)of liver left lobe,prothrombin time(PT),albumin(ALB)and liver function grading were independent risk factors for high-risk GOV(P<0.05).The area under the curve(AUC)of receiver operating characteristic(ROC)curve of predicting high-risk GOV in nomo-gram model was 0.893.Calibration curve showed that the predicted results were basically consistent with the actual results.Decision curve analysis(DCA)showed that the prediction model had good clinical practicability.Conclusion The nomogram model based on NIC of liver left lobe,PT,ALB and liver function grading is helpful to predict patients with high-risk GOV in liver cirrhosis,and pro-vides a reference for clinical prevention and treatment of esophagogastric variceal bleeding(EVB).

关 键 词：能谱CT 肝硬化 食管胃静脉曲张 列线图 

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] R571.3[医药卫生—临床医学]