感染性休克患者的肾上腺中空征:发生率、CT表现及临床后果

Hollowed adrenal gland sign in patients of septic shock: incidence, CT appearance and consequences

目的探究感染性休克患者肾上腺中空征(HAGS)的发生率、CT表现及判断预后的价值。方法回顾性分析175名感染性休克患者的CT平扫及双期增强图像及临床资料,CT检查均于患者确诊感染性休克后一周内进行。增强扫描动脉期患者肾上腺中心区域强化显著低于外周,而静脉期上述低强化区被填充,强化程度与外周一致时,将其定义为HAGS阳性。统计分析感染性休克患者HAGS的发生率,并探讨其在患者预后评估方面的作用。结果175例患者中HAGS阳性率约为30%。HAGS阳性组(53例)与阴性组(122例)两组间年龄、性别构成比均无显著差异(P=0.137,0.655)。HAGS阳性与阴性组间病死率(83.0%比49.1%)存在显著差异(P<0.001)。HAGS阳性组病死率明显高于阴性组,OR值为5.052(2.270, 11.244)。以HAGS阳性预测患者死亡的敏感度与特异度分别为42%、87%。两位放射科医师对肾上腺中空征的判断一致性良好(κ=0.986)。结论 HAGS是一种常见于感染性休克患者的特殊CT征象,其发生提示预后不良。

Objective To investigate the incidence,CT appearance and indication of prognosis of hollow adrenal gland sign(HAGS),a characteristic dual-phase enhancing pattern of adrenal gland in septic shock patients.Methods A total of 175 patients with septic shock were retrospectively included in the study,and their CT findings and clinical records were reviewed retrospectively(All the patients received a dual-phase enhanced CT scan within one week after the diagnosis of septic shock).If the central zone of adrenal gland in the arterial phase showed temporally much lower attenuation than the peripheral zone,it was defined as HAGS-positive.The incidence and indication of prognosis of the HAGS in patients were calculated and analyzed.Results The incidence of the HAGS was about 30%.There was no significant difference in age or gender composition between the HAGS positive and negative patients(53 cases vs.122 cases)(P≥0.05).And the mortality of the HAGS positive patients is significantly much higher than the negative ones(83.0%vs.49.1%,P<0.05).The concordance correlation coefficient value of the two observers was 0.986,which meant a excellent reproducibility.Conclusion The HAGS is common on CT in patients with septic shock and predicts a poor prognosis.