MSCT肝脏体积测量评估肝硬化患者肝脏功能代偿状态的可行性研究  

Feasibility study of MSCT liver volume measurement in evaluating liver function compensatory status in patients with liver cirrhosis

作　　者：张志硕 王紫仪 马宁 Zhang Zhishuo;Wang Ziyi;Ma Ning(Department of Radiology,Beijing Daxing District People's Hospital,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院放射科,102600

出　　处：《中华消化病与影像杂志(电子版)》2025年第2期155-161,共7页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的分析经临床证实的肝硬化患者的MSCT检查资料及肝功能Child-Pugh评分等临床资料,构建基于MSCT肝脏体积测量的肝脏功能代偿状态评价模型,并验证其准确性和可靠性。方法选取2020年7月至2023年7月于北京市大兴区人民医院接受MSCT检查170例肝硬化患者为研究对象,进行回顾性分析。按照3∶1比例将患者分为建模集、验证集。其中建模集144例,验证集26例。建模集根据肝功能分级Child-Pugh评分分为Child-Pugh A及B组、Child-Pugh C组。比较建模集两组的临床资料差异、CT参数CT体积、灌注参数,采用二元Logistic构建预测模型,采用ROC曲线、Z检验。比较各模型的诊断效果。结果建模集Child-Pugh C组肝性脑病、腹水占比、TBIL、INR高于Child-Pugh A及B组,ALB低于Child-Pugh A及B组,差异有统计学意义(P<0.05)。建模集Child-Pugh C组MTT长于Child-Pugh A及B组,HAF、A/V、尾状叶体积高于Child-Pugh A及B组;而BF、BV、PVP、HAP、全肝体积、右半肝体积、左内叶体积低于Child-Pugh A及B组,CAAT短于Child-Pugh A及B组(P<0.05)。根据多因素Logistic回归模型分析发现,BF、BV、MTT、HAF、PVP、CAAT、HAP、A/V、全肝体积、右半肝体积、左内叶体积和尾状叶体积均是影响肝硬化患者肝脏功能代偿状态的独立危险因素(P<0.05)。Hosmer-Lemeshow拟合度检验显示,未加入MSCT肝脏体积参数预测模型和加入MSCT肝脏体积参数预测模型差异均无统计学意义(P=0.889、0.388)。Z检验表明两种预测模型的ROC曲线下面积之差为0.037(P<0.05)。建模集加入MSCT肝脏体积参数预测模型ROC AUC达0.865(95%CI 0.814~0.936),预测效能良好。独立验证集加入MSCT肝脏体积参数预测模型AUC为0.749(95%CI 0.622~0.840)。验证集Hosmer-Lemeshow检验示模型预测与实际值一致性尚可(P=0.084)。结论MSCT肝脏体积测量在评估肝硬化患者肝脏功能代偿状态中展现出良好的应用前景。通过结合MSCT提供的肝脏体Objective To analyze the clinical data of MSCT examination and Child-Pugh score of liver function in patients with clinically proven cirrhosis,to establish the evaluation model of liver function compensatory status based on MSCT liver volume measurement,and to verify its accuracy and reliability.Methods This study was a retrospective analysis.A total of 170 patients with liver cirrhosis who underwent MSCT examination in Beijing Daxing District People's Hospital from July 2020 to July 2023 were selected as the research objects.The patients were divided into a modeling set and a validation set according to a 3∶1 ratio.There were 144 cases in the modeling set and 26 cases in the validation set.According to the total score of Child-Pugh classification of liver function,the modeling set was divided into two groups:Child-Pugh A and B group and Child-Pugh C group.The differences in clinical data,CT parameters,CT volume and perfusion parameters between the two groups were compared in the modeling set.Binary Logistic regression was used to construct the prediction model,and ROC curve and Z test were used.The diagnostic performance of each model was compared.Results In the modeling set,the proportion of hepatic encephalopathy,ascites,TBIL and INR in Child-Pugh C group were higher than those in Child-Pugh A and B group,and ALB was lower than that in Child-Pugh A and B group,with statistically significant differences(P<0.05).In the modeling set,the MTT in Child-Pugh C group was longer than that in Child-Pugh A and B group,and HAF,A/V and caudate lobe volume were higher than those in Child-Pugh A and B group.BF,BV,PVP,HAP,total liver volume,right liver volume and left medial lobe volume were lower than those in Child-Pugh A and B group,and CAAT was shorter than that in Child-Pugh A and B group(P<0.05).According to multivariate Logistic regression model analysis,BF,BV,MTT,HAF,PVP,CAAT,HAP,A/V,total liver volume,right liver volume,left medial lobe volume and caudate lobe volume were all independent risk factors affecting live

关 键 词：肝硬化 体层摄影术 螺旋计算机 肝脏体积 肝脏储备 

分 类 号：R575.2[医药卫生—消化系统]