门静脉和胃左静脉内径与肝功能分级及食管胃底静脉曲张破裂出血的关系

Relationships of portal vein and left gastric vein diameter with Child-Pugh classification of liver cirrhosis and esophagealgastric variceal bleeding

目的探讨肝硬化患者门静脉主干(main portal vein,MPV)和胃左静脉(left gastric vein,LGV)内径与肝功能Child-Pugh分级及食管胃底静脉曲张破裂出血(esophagogastric variceal bleeding,EVB)的关系。方法 90例肝硬化患者中54例有EVB史者为出血组,36例无出血史者为无出血组。患者均行门静脉系统CT血管成像,测量MPV及LGV内径,分析MPV及LGV内径与肝功能Child-pugh分级及EVB的相关性;采用ROC曲线判断MPV及LGV内径值对EVB的预测价值。结果 Child-pugh分级A、B、C级患者,MPV内径分别为(15.26±2.79)、(15.37±2.75)、(16.17±2.40)mm,其差异均无统计学意义(P>0.05);LGV内径分别为(5.25±1.41)、(6.49±1.97)、(6.58±2.44)mm,Childpugh分级B、C级患者LGV内径较A级患者增宽(P<0.05);EVB发生率分别为44.44%、67.65%、75.00%,差异均有统计学意义(P<0.05);出血组MPV内径[(15.75±2.23)mm]与无出血组[(15.14±3.25)mm]比较差异无统计学意义(P>0.05),LGV内径[(6.86±1.94)mm]较无出血组[(4.75±1.21)mm]增宽(P<0.05);(3)LGV内径值预测肝硬化患者发生EVB的最佳临界值为5.97mm,敏感度为81.5%,特异度为80.6%。结论 LGV内径可反映肝硬化患者肝脏储备功能,预测EVB发生的可能性。

Objective To investigate the relationships of the diameters of main portal vein （MPV） and left gastric vein （LGV） with Child-Pugh classification of liver cirrhosis and esophagogastric variceal bleeding （EVB）. Methods In 90 patients with liver cirrhosis, 54 had EVB history （EVB group） and 36 had no EVB history （non-EVB group）. Both two groups underwent CT angiography of portal venous system, and the diameters of the MPV and LGV were measured. The relationships of the diameters of MPV and LGV with Child-Pugh classification and EVB were analyzed. ROC curves were generated and the AUC values were calculated to assess the value of the diameters of MPV and LGV to predicting EVB in cirrhotic patients. Results In Child-Pugh A, B and C patients, the diameters of MPV were （15.26±2.79）, （15.37±2.75） and （16.17±2.40） mm, showing no significant differences （P〈0.05）, while the diameters of LGV were （5. 25± 1.41） mm in Child-Pugh A patients, shorter than those in Child-Pugh B and C patients （（6.49±1.97）, （6. 58±2.44） mm） （P〈0.05）. The incidences of EVB differed among Child-Pugh A, B and C patients （44.44%, 67.65%, 75.00%） （P〈0.05）. There was no significant difference in the diameters of MPV between EVB group （（15.75 ±2.23） mm） and non-EVB group （（15. 14±3.25） mm） （P〈0. 05）, while the diameter of LGV was longer in EVB group （（6. 86±1.94） mm） than that in non-EVB group （（4. 75±1.21） mm） （P〈0.05）. The optimal cut-off value of the diameter of LGV for predicting EVB in cirrhotic patients was 5. 97 ram, with the sensitivity of 81. 5% and the specificity of 80. 6~//00. Conclusion The diameter of LGV can be used to reflect the liver reverse function and predict the occurrence of EVB in patients with liver cirrhosis.