能谱CT联合肝脏体积评估肝硬化并发食管静脉曲张价值研究*

doi:10.3969/j.issn.1672-5069.2026.04.025

摘要/Abstract

摘要： 目的探讨肝硬化并发食管静脉曲张(EV)患者能谱CT定量参数变化及其临床意义。方法 2024年1月～2025年6月我院诊治的67例乙型肝炎肝硬化患者,均接受胃镜检查,发现高风险EV者34例和低风险EV者33例。行肝脏能谱CT扫描,测量肝脏碘浓度(IC)、标准化碘浓度(NIC)、有效原子序数(Zeff)和能谱曲线斜率(λHU)及总肝体积(TLV)、标准化肝体积(SLV)和功能性肝体积(FLV)。采用Logistic回归分析影响高风险EV发生的因素。结果高风险EV组Child-Pugh C级和脾肿大占比、MELD评分、血清总胆红素和INR均显著大于或高于(P<0.05),而外周血血小板计数和血清白蛋白水平均显著低于低风险EV组(P<0.05);高风险EV组IC、NIC、Zeff和λHU分别为(1.4±0.3)mg/ml、(0.4±0.1)、(7.3±0.2)和(1.4±0.4),均显著小于低风险组【分别为(1.6±0.3)mg/ml、(0.5±0.1)、(7.7±0.2)和(1.6±0.4),P<0.05】;高风险组TLV、SLV、FLV和FLV/体表面积(BSA)分别为(1086.2±205.6)ml、(664.8±103.5)ml/m²、(958.3±183.4)ml和(585.3±94.1)ml/m²,均显著小于低风险组【分别为(1243.6±221.4)ml、(731.6±110.8)ml/m²、(1114.2±198.1)ml和(654.3±101.7)ml/m²,P<0.05】;多因素Logistic回归分析显示,Child-Pugh分级、PLT计数、IC、NIC、Zeff和FLV均为高风险EV发生的独立危险因素(P<0.05);在随访1年末,本组患者发生EVB者12例,其中高风险组11例(32.4%),低风险组1例(3.0%,P<0.05)。结论测量肝硬化患者能谱CT定量参数和肝脏体积有助于判断EV风险,及时给予必要的干预可能防止EVB的发生。

关键词: 肝硬化, 食管静脉曲张, 能谱CT, 肝脏碘浓度, 标准化碘浓度, 有效原子序数, 能谱曲线斜率, 总肝体积, 标准化肝体积

Abstract: Objective The aim of this study was to assess esophageal varices (EV) by spectral CT parameters in patients with hepatitis B-induced liver cirrhosis (LC). Methods 67 patients with hepatitis B-induced LC were encountered in our hospital between January 2024 and June 2025, and all patients underwent gastroscopy that found high risk EV in 34 cases and low-risk EV in 33 cases. Abdominal spectral CT scan was performed to record liver iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number (Zeff) and spectral curve slope (λHU), total liver volume (TLV), standardized liver volume (SLV), functional liver volume (FLV) and FLV/body surface area (BSA) (FLV/BSA) ratio was calculated. Multivariate Logistic regression analysis was applied to find impacting factors. Results Percentages of Child-Pugh class C and splenomegaly, MELD score, total serum bilirubin and INR in patients with high-risk EV were all significantly greater or higher than (P<0.05), while platelet count and serum albumin level were significantly lower than in those with low-risk EV (P<0.05); IC, NIC, Zeff and λHU were (1.4±0.3)mg/ml, (0.4±0.1), (7.3±0.2) and (1.4±0.4), all much smaller than [(1.6±0.3)mg/ml, (0.5±0.1), (7.7±0.2) and (1.6±0.4), respectively, P<0.05] in patients with low-risk EV; TLV, SLV, FLV and FLV/BSA ratio were (1086.2±205.6)ml, (664.8±103.5)ml/m², (958.3±183.4)ml and (585.3±94.1)ml/m², all much smaller than [(1243.6±221.4)ml, (731.6±110.8)ml/m², (1114.2±198.1)ml and (654.3±101.7)ml/m², respectively, P<0.05] in those with low-risk EV; multivariate Logistic regression analysis showed that Child-Pugh classification, PLT count, IC, NIC, Zeff and FLV were all the independent risk factors for high-risk EV occurrence (P<0.05); by end of one-year follow-up, EV bleeding (EVB) happened in 12 cases in our series, of which 11 patients (32.4%) in high-risk EV and 1 (3.0%, P<0.05) in those with low-risk EV. Conclusion Spectral CT quantitative parameters, including liver volume measurement, could help predict EV or even EVB risk in patients with LC, and an appropriate preventive measures should be given to improve the prognosis.

Key words: Liver cirrhosis, Esophageal varices, Spectral computed tomography, Liver iodine concentration, Normalized iodine concentration, Effective atomic number, Spectral curve slope, Total liver volume, Standardized liver volume

陈玲, 刘宏, 张新灵, 吕晓波, 卢瑞芳, 鲁瑞. 能谱CT联合肝脏体积评估肝硬化并发食管静脉曲张价值研究^*[J]. 实用肝脏病杂志, 2026, 29(4): 577-580.

Chen Ling, Liu Hong, Zhang Xinling, et al. Assessment of esophageal varices by spectral CT parameters in patients with hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2026, 29(4): 577-580.

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能谱CT联合肝脏体积评估肝硬化并发食管静脉曲张价值研究^*

Assessment of esophageal varices by spectral CT parameters in patients with hepatitis B-induced liver cirrhosis

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