腹部CT联合血清学指标对特发性腹膜后纤维化输尿管受累的预测价值  

Predictive Value of Abdominal CT Images Combined With Serological Indicators for Ureteral Involvement in Idiopathic Retroperitoneal Fibrosis

作　　者：王婷婷 姜超 李宁 孙露露 田卢峰 吴哲 WANG Tingting;JIANG Chao;LI Ning;SUN Lulu;TIAN Lufeng;WU Zhe(Postgraduate Training Base,Fushun Central Hospital of Jinzhou Medical University,Fushun,Liaoning 113006,China;Department of Radiology,Fushun Central Hospital,Fushun,Liaoning 113006,China)

机构地区：[1]锦州医科大学抚顺市中心医院研究生培养基地,辽宁抚顺113006 [2]抚顺市中心医院放射科,辽宁抚顺113006

出　　处：《中国医学科学院学报》2025年第1期48-54,共7页Acta Academiae Medicinae Sinicae

摘　　要：目的分析腹部CT联合血清学相关指标对特发性腹膜后纤维化(IRF)输尿管受累的预测价值。方法回顾性分析79例IRF患者的CT图像,包括病变累及部位及强化特点。根据纳入和排除标准,选取其中43例血清学资料完整的病例,根据IRF输尿管是否受累,分为输尿管受累组(n=29)和未受累组(n=14)。采用Logistic回归分析筛选IRF输尿管受累的独立危险因素,绘制受试者工作特征(ROC)曲线评价CT动脉期强化幅度、血清胱抑素C(CysC)对IRF输尿管受累的预测价值。结果IRF CT影像通常表现为包绕腹主动脉、髂动脉、输尿管及腹膜后组织的软组织密度病灶,分布范围广泛。IRF输尿管受累组和未受累组患者性别(P=0.031)、CT动脉期强化幅度(P=0.014)、CT静脉期强化幅度(P=0.032)、血清CysC(P=0.036)比较差异均有统计学意义。Logistic回归分析结果显示性别(P=0.034)、CT动脉期强化幅度(P=0.046)、血清CysC(P=0.041)是IRF输尿管受累的独立危险因素。CT动脉期强化幅度联合血清CysC预测IRF输尿管受累的曲线下面积为0.776。10例随访患者血沉(P<0.001)、C反应蛋白(P=0.021)及IgG4水平(P<0.001)均低于治疗前。结论腹部CT联合血清学相关指标预测IRF发生输尿管受累的准确性较高,为临床早期诊断提供参考。Objective To analyze the value of abdominal CT images combined with serological indicators in predicting the ureteral involvement in idiopathic retroperitoneal fibrosis(IRF).Methods The CT images of 79 IRF patients were analyzed retrospectively,including the involved sites and enhancement characteristics of the lesions.According to the inclusion and exclusion criteria,43 patients with complete serological data were selected and assigned into a ureteral involvement group(n=29)and a non-ureteral involvement group(n=14)according to whether ureters were involved in IRF.Logistic regression analysis was performed to select independent risk factors for ureteral involvement in IRF.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of the CT arterial phase enhancement magnitude and serum cystatin C(CysC)for ureteral involvement in IRF.Results The CT images of IRF usually showed a soft tissue density lesion encompassing the abdominal aorta,iliac arteries,ureters,and retroperitoneal tissue,with a wide range of distribution.The ureteral involvement group and the non-ureteral involvement group showed differences in gender(P=0.031),CT arterial phase enhancement amplitude(P=0.014),CT venous phase enhancement amplitude(P=0.032),and serum CysC(P=0.036).Logistic regression analysis showed that gender(P=0.034),CT arterial phase enhancement amplitude(P=0.046),and serum CysC(P=0.041)were independent risk factors for ureteral involvement in IRF.The area under the curve for CT arterial phase enhancement combined with serum CysC to predict ureteral involvement in IRF was 0.776.Ten patients had lower levels of erythrocyte sedimentation rate(P<0.001),C-reactive protein(P=0.021),and IgG4(P<0.001)in the follow-up period than before treatment.Conclusion The combination of abdominal CT images with serological indicators demonstrates high accuracy in predicting the ureteral involvement in IRF,providing reference for early clinical diagnosis.

关 键 词：特发性腹膜后纤维化 IGG4相关性疾病 CT 影像诊断 血清学 

分 类 号：R445.3[医药卫生—影像医学与核医学]