肝硬化食管静脉曲张出血风险的MSCTA评估研究

The Value of MSCTA in Assessing the Risk of Esophageal Varicose Hemorrhage in Patients with Cirrhosis

目的探讨多层螺旋CT血管成像对肝硬化门脉高压食管静脉曲张出血的评估价值。方法对104例肝硬化门脉高压患者的一般资料与食管静脉曲张出血的相关性进行分析,观察其门脉系统及侧支血管的情况,分析以上血管与食管静脉曲张出血的相关性。通过对门静脉、胃左静脉及副脐静脉按照血管直径积分方法进行积分,采用受试者工作曲线找到CTA积分值及胃镜分级各自判断出血的cut-off值。同时,将CTA积分联合胃镜分级随访后期肝硬化门脉高压患者的MSCTA图像,分析CTA积分联合胃镜分级诊断食管静脉曲张出血发生的敏感度及特异度。结果104例肝硬化门脉高压患者的一般资料中EV出血组与非出血组间差异有统计学意义的指标有Child-pugh分级、血小板数。分析的血管中LGV、PUV、PV 3支血管分别与EV胃镜分级、EV出血组和非出血组差异有统计学意义(P<0.05)。脾静脉、脾肾静脉分流、胃肾静脉分流与EV出血组/非出血组组间差异无统计学意义(P>0.05)。将出血组和非出血组差异有统计学意义的PV、LGV及PUV纳入CTA积分,积分值范围0~6分。CTA积分与EVH的ROC曲线显示cut-off值>3时,敏感性为79.5%,特异性为53.3%。EV胃镜级与EVH的ROC曲线显示胃镜分级>3时,敏感性为81.8%,特异性为73.3%,AUC线下面积0.773。CTA积分联合胃镜分级评估EVH的敏感度为85.7%,特异度为79.7%。CTA积分联合胃镜分级方式随访后期54例病例,诊断肝硬化门脉高压患者出血的敏感性为77.8%,特异性为70.4%。结论MSCTA对观察肝硬化门脉高压侧支血管的直径和范围有准确判断,肝硬化门脉高压CTA积分方法对评估EVH的发生有重要价值。

Objective To explore the value of multiple slice spiral computed tomography angiography(MSCTA)in assessing esophageal varicose hemorrhage(EVH)in patients with cirrhotic portal hypertension.Methods The correlation between the general data and EVH of 104 patients with cirrhotic portal hypertension was analyzed.The collateral vessels of the portal system were observed to analyze the correlation between the status of those vessels and EVH.The method of vessel diameter integral was used to integrate portal vein,left gastric vein and paraumbilical vein,and the ROC curve was adopted to calculate the computed tomography angiography(CTA)integral values and cut-off values of different grades in gastroscopy.The MSCTA images of patients with cirrhotic portal hypertension were followed up with the CTA integral values combined with gastroscopic grading and the sensitivity and specificity of the CTA integral values combined with gastroscopic grading in the diagnosis of EVH were analyzed.Results There were significant differences between the bleeding group and non-bleeding group in the Child-pugh grade and platelet count among the general data of 104 patients with cirrhotic portal hypertension.The statistical differences were found in left gastric vein,paraumbilical vein and portal vein between the different grades in gastroscopy and between the bleeding group and non-bleeding group respectively(P<0.05).There were no significant differences in splenic vein,splenic-renal vein shunt,gastro-renal vein shunt between the bleeding group and non-bleeding group(P>0.05).The gastroscopic grades of left gastric vein,paraumbilical vein and portal vein were taken into the CTA integral values which ranged from zero to six.When the CTA integral values and ROC curve showed that the cut-off value was greater than 3,the sensitivity and specificity were 79.5%and 53.3%respectively.When the gastroscopic grading and ROC curve showed that the gastroscopic grade was greater than 3,the sensitivity and specificity were 81.8%and 73.3%respectively and the area under curve was 0.773.The sensitivity and specificity were 85.7%and 79.7%respectively in assessing EVH with the CTA integral values combined with gastroscopic grading.The sensitivity and specificity were 77.8%and 70.4%respectively in the 54 cases followed up with the CTA integral values combined with gastroscopic grading.Conclusion MSCTA is accurate in judging the diameter and range of the collateral vessels in cirrhotic portal hypertension,and the CTA integral method has important values in evaluating the occurrence of EVH in cirrhotic portal hypertension.