多层螺旋CT指标对普萘洛尔治疗的肝硬化患者发生食管静脉曲张出血的预测意义  

Predictive value of multislice spiral CT indicators for propranolol prophylactic treatment of esophageal variceal bleeding of patients with liver cirrhosis

作　　者：汪克文[1] 郑健荪[2] 张忠杰[3] 王东平 王煜[1] WANG Kewen;ZHENG Jiansun;ZHANG Zhongjie;WANG Dongpin;WANG Yu(Department of Gastroenterology,Huangshan People's Hospital,Huangshan 245000,Anhui,China;Department of Infectious Diseases,Huangshan People's Hospital,Huangshan 245000,Anhui,China;CT Room,Huangshan People's Hospital,Huangshan 245000,Anhui,China;CT Room,the Second Hospital of Zunhua,Zunhua 064200,Hebei,China)

机构地区：[1]黄山市人民医院消化内科,安徽黄山245000 [2]黄山市人民医院感染科,安徽黄山245000 [3]黄山市人民医院CT室,安徽黄山245000 [4]遵化市第二医院CT室,河北遵化064200

出　　处：《贵州医科大学学报》2025年第3期461-468,共8页Journal of Guizhou Medical University

基　　金：河北省科技攻关计划项目(20160910)。

摘　　要：目的探讨基于多层螺旋CT(multi-detector-row computed tomography,MDCT)指标(肝脾体积和门静脉直径)的普萘洛尔治疗肝硬化患者发生食管静脉曲张出血(variceal hemorrhage,VH)风险的预测模型。方法126例普萘洛尔治疗肝硬化患者分为训练组(n=86)和验证组(n=40),收集2组肝硬化患者的一般临床资料[年龄、性别、有无肝硬化及肝硬化属于乙型肝炎病毒(hepatitis B virus,HBV)或HCV、酒精史、Child-Pugh评分、红点征、腹水、肝性脑病、白蛋白水平、总胆红素水平、凝血酶原时间及血小板水平],利用MDCT测量2组肝硬化患者肝脏总体积(total liver volume,TLV)、左外侧肝叶体积(left lateral liver lobe volume,LLV)、左内侧肝叶体积(left medial liver lobe volume,LMV)、右肝叶体积(right liver lobe volume,RV)、尾状叶体积(caudate lobe volume,CV)及脾脏体积(spleen volume,SV)并计算SV/TLV、SV/LLV、SV/LMV、SV/RV、SV/CV,同时测量左胃静脉直径(left gastric vein diameter,LGVD)、门静脉直径(portal vein diameter,PVD)、右门静脉直径(right portal vein diameter,RPVD)、左门静脉直径(left portal vein diameter,LPVD)、脾静脉直径(splenic vein diameter,,SVD)及脾静脉直径均值(splenic mean vein diameter,SMVD)并计算组间相关系数(intraclass correlation coefficient,ICC);门诊或电话随访2组肝硬化患者出院后的2年内,收集食管VH的发生情况,采用单变量分析和多因素分析训练组肝硬化患者食管VH的独立预测因子并建立食管VH预测模型,通过受试者操作特征(ROC)曲线分析评估其性能,采用Kappa检验分析验证组肝硬化患者预测模型的一致性。结果训练组食管VH患者TLV低于非VH患者,SV、SV/TLV、SV/LLV、SV/LMV、SV/RV、SV/CV、LGVD、PVD、LPVD、RPVD、SMVD及SVD高于非VH组(P<0.05);单因素回归分析表明,LGVD和SVD是肝硬化患者发生食管VH的独立危险因素(P<0.05),并构建了食管VH预测模型;ROC曲线分析显示,LGVD、SVD和预测模型的曲线Objective To explore a predictive model for the risk of esophageal variceal hemorrhage(VH)of patients with hepatic cirrhosis in the prophylactic treatment with propranolol,based on multidetector computed tomography(MDCT)indicators(liver and spleen volumes and portal vein diameter).Methods A total of 126 patients with hepatic cirrhosis in the prophylactic treatment with propranolol,were divided into the training group(n=86)and the validation group(n=40).General clinical data were collected for both groups,including age,gender,presence of cirrhosis,etiology of cirrhosis(HBV or HCV),history of alcohol use,Child-Pugh score,presence of red signs,ascites,hepatic encephalopathy,albumin level,total bilirubin level,prothrombin time,and platelet count.MDCT was used to measure total liver volume(TLV),left lateral liver volume(LLV),left medial liver volume(LMV),right liver volume(RV),caudate lobe volume(CV),and spleen volume(SV),and to calculate SV/TLV,SV/LLV,SV/LMV,SV/RV,and SV/CV.Additionally,the diameters of the left gastric vein diameter(LGVD),portal vein diameter(PVD),right portal vein diameter(RPVD),left portal vein diameter(LPVD),splenic vein diameter(SVD),and mean splenic vein diameter(MSVD)were measured,and the interclass correlation coefficient(ICC)was calculated.VH occurrence within two years'post-discharge was collected through outpatient or telephone follow-ups.Univariate and multivariate analyses were used to identify independent predictors of VH in the training group,and VH predictive model was established.The performance of the model was evaluated using receiver operating characteristic(ROC)curve analysis,and the consistency of the predictive model in the validation group was analyzed using the Kappa test.Results TLV was lower in VH patients compared with non-VH patients in the training group,while SV,SV/TLV,SV/LLV,SV/LMV,SV/RV,SV/CV,LGVD,PVD,LPVD,and SVD were higher in the VH group(P<0.05).Univariate regression analysis indicated that LGVD and SVD were independent risk factors for VH(P<0.05),and VH predictiv

关 键 词：肝硬化 普萘洛尔 食管静脉曲张 出血风险 预测模型 多层螺旋CT 

分 类 号：R575.2[医药卫生—消化系统]