增强CT扫描与超声在诊断肝硬化门脉高压食管静脉曲张破裂出血中的应用

The Application of Enhanced CT Scan and Ultrasound in the Diagnosis of Portal Hypertension Liver Cirrhosis with Esophageal Variceal Bleeding

目的分析增强CT扫描与超声在诊断肝硬化门脉高压食管静脉曲张破裂出血中的应用。方法将我院确诊且经临床病理证实为肝硬化门静脉高压的40例患者纳入研究范围,分析方式其临床资料及影像学资料,并参照消化内镜检查结果,以有无曲张静脉破裂出血暴露分组,对比门静脉主干(MPV)管径、胃左静脉(LGV)管径、计算门静脉充血指数(PV-CI)、肝静脉减振指数(HV-DI)、肝动脉渡越时间(HAAT)、肝静脉-肝动脉渡越时间(HV-HA)的差异,并采用ROC曲线分析有差异项目在肝硬化门脉高压食管静脉曲张破裂出血中的诊断价值。结果以消化内镜检查是否有食管静脉曲张破裂出血暴露分组,其中19例纳入出血组,21例纳入未出血组,经对比分析可见出血组LGV、HV-DI显著高于未出血组,HA-HA显著低于未出血组,且对比差异有统计学意义;经ROC曲线分析,LGV、HV-DI、HV-HA预测曲张静脉破裂出血的阳性阀值依次为6.00mm、0.66、5.50s,诊断敏感度依次为LGV(82.87%)﹥HV-DI(75.57%)﹥HV-HA(46.26%),诊断特异度依次为HV-HA(84.57%)﹥LGV(78.36%)﹥HV-DI(69.19%)。结论增强CT扫描与超声应用于肝硬化门脉高压食管静脉曲张破裂出血诊断时,两者在敏感度、特异度上各具优势。

Objective To analyze the application of enhanced CT scan and ultrasound in the diagnosis of portal hypertension liver cirrhosis with esophageal variceal bleeding. Methods40 patients with portal hypertension liver cirrhosis confirmed by clinicopathological diagnosis in the hospital from January 2013 to September 2017 were enrolled in the study. Their clinical data and imaging data were analyzed retrospectively. According to the results of gastrointestinal endoscopy and the presence of variceal bleeding, the patients were grouped. The diameter of main portal vein（MPV）, diameter of left gastric vein（LGV）, portal vein congestion index（PV-CI）, hepatic vein damping index（HV-DI）, hepatic arterial arriving time（HAAT） and hepatic vein interval time（HV-HA） were compared. The value of items with significant differences in the diagnosis of portal hypertension liver cirrhosis with esophageal variceal bleeding was analyzed by ROC curve. Results There were 19 cases with variceal bleeding（the bleeding group） and 21 cases without（nonbleeding group）. The LGV and HV-DI in bleeding group were significantly higher than those in the non-bleeding group, and HA-HA was significantly lower than in nonbleeding group. ROC curve analysis showed that the positive thresholds of LGV, HV-DI and HV-HA in predicting variceal bleeding were 6.00 mm, 0.66 and 5.50 s, respectively. The diagnostic sensitivity showed LGV（82.87%） 〉 HV-DI（75.57%） 〉 HV-HA（46.26%）, and the specificity showed HV-HA（84.57%） 〉 LGV（78.36%） 〉 HV-DI（69.19%）. Conclusion Enhanced CT scan and ultrasound have their own advantages in the diagnosis of portal hypertension liver cirrhosis with esophageal variceal bleeding, in terms of sensitivity and specificity.