CTP定量参数预测失代偿期肝硬化患者并发食管胃底静脉曲张破裂出血价值研究*

doi:10.3969/j.issn.1672-5069.2025.03.025

摘要/Abstract

摘要： 目的探讨CT门静脉造影(CTP)定量参数预测失代偿期肝硬化并发门脉高压和食管胃底静脉曲张破裂出血(EVB)的价值。方法 2021年1月～2023年3月我院收治的失代偿期乙型肝炎肝硬化患者98例,均接受胃镜和CTP检查,记录CTP定量参数。行门脉压力梯度(PPG)测定,诊断门脉高压。构建受试者工作特征曲线(ROC)分析CTP定量参数诊断显著性门静脉高压的价值。随访12个月,分析CTP定量参数预测EVB发生的效能。结果在98例肝硬化患者中,发现EV者47例(48.0%)和显著性门静脉高压症45例(45.9%);显著性门静脉高压患者门静脉主干直径、脾静脉直径、胃左静脉直径、肝内门静脉左支直径和肝内门静脉右支直径分别为(17.6±1.8)mm、(15.9±1.9)mm、(6.1±1.3)mm、(13.0±1.3)mm和(12.6±1.7)mm,均显著大于非显著性门静脉高压患者【分别为(14.9±2.0)mm、(14.0±2.0)mm、(4.6±1.6)mm、(11.3±1.4)mm和(11.3±1.6)mm,P＜0.05];随访12个月,98例肝硬化患者发生EVB 22例(22.5%);出血患者基线门静脉主干直径、脾静脉直径、胃左静脉直径、肝内门静脉左支直径和肝内门静脉右支直径均显著大于未出血患者(P＜0.05);以满足门脉系统指标中的任何三个条件诊断显著性门静脉高压的AUC均大于0.830(P＜0.05),敏感性大于75.6%,特异性大于79.3%,预测EVB的AUC均大于0.755(P＜0.05),敏感性大于68.2%,特异性大于71.1%。结论应用CTP定量参数可以诊断肝硬化患者显著性门静脉高压,并可预测EVB的发生,具有一定的临床应用价值。

关键词: 肝硬化, CT门静脉造影, 门脉高压, 食管胃底静脉曲张破裂出血, 诊断

Abstract: Objective The aim of this study was to explore CT portography (CTP) quantitative parameters in predicting portal hypertension and esophagogastric variceal bleeding (EVB) in patients with decompensated liver cirrhosis (DLC). Methods A total of 98 patients with decompensated hepatitis B-induced liver cirrhosis were encountered in our hospital between January 2021 and March 2023, and all underwent CTP, gastroscopy and portal pressure gradient (PPG) determination. Patients were followed-up for 12 months, and receiver operating characteristic (ROC) curve was applied to evaluate predictive performance. Results Of 98 patients with liver cirrhosis in our series, esophagogastric varices (EV) was found in 47 cases(48.0%) and significant portal hypertension (SPH) in 45 cases (45.9%); diameters of main portal vein, splenic vein, left gastric vein, left branch and right branch of intrahepatic portal vein in patients with SPH were (17.6±1.8)mm, (15.9±1.9)mm, (6.1±1.3)mm, (13.0±1.3)mm and (12.6±1.7)mm, all significantly greater than [(14.9±2.0)mm, (14.0±2.0)mm, (4.6±1.6)mm, (11.3±1.4)mm and (11.3±1.6)mm, respectively, P＜0.05] in those with non-SPH(NSPH); during 12-month follow-up, EVB occurred in 22 cases (22.5%), and baseline diameters of five portal veins mentioned above in patients with EVB were all much greater than in those without EVB(P＜0.05); the AUC was 0.830(P＜0.05), with sensitivity (Se) of greater than 75.6% and specificity (Sp) of greater than 79.3%, or the AUC was 0.755(P＜0.05, with Se of greater than 68.2% and Sp of greater than 71.1% in predicting SPH or EVB when any combination of three parameters from the five was met. Conclusion CTP quantitative parameters have certain clinical diagnostic efficacy in predicting SPH and EVB in cirrhotic patients, and needs further investigation.

Key words: Liver cirrhosis, Portal hypertension, Esophagogastric variceal bleeding, CT portography, Diagnosis

高建军, 张华西, 范仁宝, 王玺. CTP定量参数预测失代偿期肝硬化患者并发食管胃底静脉曲张破裂出血价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 418-421.

Gao Jianjun, Zhang Huaxi, Fan Renbao, et al. CT portography quantitative parameters in predicting portal hypertension and esophagogastric variceal bleeding in patients with decompensated liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(3): 418-421.

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CTP定量参数预测失代偿期肝硬化患者并发食管胃底静脉曲张破裂出血价值研究^*

CT portography quantitative parameters in predicting portal hypertension and esophagogastric variceal bleeding in patients with decompensated liver cirrhosis

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