比较256层CT测得脾指数与食管静脉管径对食管静脉曲张的应用价值

Compare application value of CT splenic index and maximum short axis in esophageal varices

(1)目的比较256层CT测得的脾指数(splenic index,SI)与食管静脉管径(d)在诊断食管静脉曲张(esophageal varices,EV)、预测EV破裂出血方面的应用价值。(2)方法以胃镜为金标准将100位肝硬化门静脉高压患者分为患有EV组(81例)、无EV组(19例)或低风险EV组(41例)、高风险EV组(59例)。用256层CT测得每组每位患者的SI及d。应用两个独立样本T检验、Spearman相关性分析、构建受试者工作特征曲线(receiver operating characteristic,ROC)及四格表资料χ2检验对CT测得的SI及d进行统计学分析。(3)结果患有EV组的SI(1162.80±305.03)较无EV组SI(732.47±194.31)明显增大(t=-5.86,P<0.05),d(4.94±1.68)较无EV组d(1.95±0.90)明显增宽(t=-10.71,P<0.05)。高风险EV组的SI(1259.80±294.55)较低风险EV组SI(823.88±183.35)明显增大(t=-8.41,P<0.05),d(5.64±1.38)较低风险EV组d(2.54±0.93)明显增宽(t=-13.42,P<0.05)。SI或d与EV的有无及EV破裂出血风险性的高低均存在显著正向线性相关关系(r=0.589、r=0.749,r=0.637、r=0.845,P均<0.001)。在诊断EV及预测EV破裂出血方面,d的准确性均高于SI(0.968>0.933、0.995>0.939)。以所得SI的cut off值(948.0,970.0)或d的cut off值(3.2,3.9)为标准,比较CT与胃镜诊断EV、预测EV破裂出血的检查结果,差异无统计学意义(P=0.33、P=0.11,P=0.98、P=0.25,P均>0.05)。(4)结论 256层CT测得的SI或d在诊断EV、预测EV破裂出血方面均有应用价值,但d的应用价值要高于SI。

Objective To comparethe ability of CT splenic index and the maximum short axis to diagnose esophageal varices(EV)and predict the risk of EV hemorrhage.Methods According to endoscopic,100 patients with cirrhotic portal hypertension were divided into positive(81),negative(19)or risk-high(41),risk-low(59).SI or d of each groupwas measured by CT.Student's test,Spearman correlation analysis,receiver operating characteristic(ROC)curveandχ2 test were used for statistical analysis.Results Positive of SI(1162.80±305.03)or d(4.94±1.68)than negative(732.47±194.31,1.95±0.90)increased significantly(t =-5.86,t =-10.71,P <0.05).Risk-high of SI(1259.80±294.55)or d(5.64±1.38)than risk-low(823.88±183.35,2.54±0.93)increased significantly(t=-8.41,t=-13.42,P <0.05).Spear-man correlation analysis suggested a positive correlation between SI or d and EV or the risk of EV hemorrhage(r =0.589,r =0.749,r =0.637,r =0.845,P <0.001).The accuracy of d was better than SI in the diagnosis of EV and the prediction of EV hemorrhage(0.968>0.933,0.995>0.939).With the standard of SI(948.0,970.0)or d(3.2,3.9),there was no statistical significance between CT and endoscopic(P =0.33、P =0.11,P =0.98、P =0.25,P >0.05).Conclusion The application of CT SI or d to diagnose EV and predict the risk of EV hemorrhage all was great,but the value of d is better than SI.