CT门静脉成像在肝硬化食管胃静脉曲张中的应用价值

Application of CT Portography in Esophagogastric Varices in Cirrhotic Patients

背景:CT门静脉成像(CTP)可直观地显示门静脉及其侧支循环,为临床常用的门静脉高压评估方法。目的:评价CTP在肝硬化食管胃静脉曲张中的应用价值。方法:回顾性收集2013年1月—2015年9月在青岛大学附属医院行CTP和胃镜检查并符合纳入标准的肝硬化患者143例,根据入院时有无消化道出血分为出血组(n=70)和未出血组(n=73)。采用Kappa一致性检验分析CTP与胃镜检查结果的一致性,采用ROC曲线分析CTP参数门静脉主干(MPV)、脾静脉(SPV)、胃左静脉(LGV)直径预测食管胃静脉曲张破裂出血的准确性。结果:CTP与胃镜检查判断食管胃静脉曲张的分型、分级一致性较好(κ=0.793,0.775)。出血组MPV、SPV、LGV直径均显著宽于未出血组(P<0.01),三者预测食管胃静脉曲张破裂出血的ROC曲线下面积(AUC)分别为0.741、0.627和0.816,LGV直径的准确性最高,以6.1 mm为界值,其敏感性和特异性分别为65.71%和84.93%;MPV直径以16.3 mm为界值时,敏感性(75.71%)优于LGV和SPV。结论:CTP可用于肝硬化食管胃静脉曲张的临床诊断,其参数LGV、MPV直径有助于静脉曲张破裂出血的预测。

Background： CT portography（ CTP） permits comprehensive evaluation of portal vein and its collateral pathways. It is widely used for assessment of portal hypertension in clinical practice. Aims： To assess the value of CTP in esophagogastric varices in cirrhotic patients. Methods： A retrospective cohort study was performed in 143 cirrhotic patients admitted from Jan. 2013 to Sep. 2015 at the Affiliated Hospital of Qingdao University. All patients fulfilled the inclusion criteria and underwent CTP and gastroscopy within 7 days after admission. According to the occurrence of gastrointestinal bleeding at admission,patients were allocated into two groups： bleeding group（ n = 70） and non-bleeding group（ n = 73）.Consistency of the results of CTP and gastroscopy was analyzed by kappa coefficient; the accuracy of CTP parameters,including diameters of main portal vein（ MPV）,splenic vein（ SPV） and left gastric vein（ LGV） for prediction of variceal bleeding was evaluated by ROC curve. Results： CTP and gastroscopy had a good consistency in typing and grading of esophagogastric varices,with the kappa value of 0. 793 and 0. 775,respectively. The diameters of MPV,SPV and LGV were significantly higher in bleeding group than in non-bleeding group（ p〈0. 01）,and their area under the ROC curve（ AUC） in predicting variceal bleeding was 0. 741,0. 627 and 0. 816,respectively. The accuracy of diameter of LGV was superior to that of MPV and SPV. With the cutoff value of 6. 1 mm,the sensitivity and specificity of diameter of LGV were65. 71% and 84. 93%,respectively. With the cutoff value of 16. 3 mm,the sensitivity of diameter of MPV was 75. 71%,which was higher than that of LGV and SPV. Conclusions： CTP can be used in clinical diagnosis of esophagogastric varices in cirrhotic patients,and two CTP parameters,the diameters of LGV and MPV,might be helpful for prediction of variceal bleeding.