肝窦阻塞综合征CT图像定量分析与预后的相关性临床研究

Correlation between CT quantitation and prognosis in pyrrolidine alkaloid-related hepatic sinus obstruction syndrome

目的探讨土三七(吡咯烷生物碱)相关肝窦阻塞综合征(HSOS)的临床及CT影像特点,分析肝脏病变区域体积与患者临床严重程度及预后关系。方法回顾性分析2015年4月~2020年3月临床确诊的45例土三七相关HSOS患者的临床资料,其中12例经病理确诊。应用CT兴趣体积法定量测定CT图像中肝脏病变区域体积,采用单因素ANOVA分析比较HSOS肝脏病变区域体积与临床严重程度关系,Kaplan-Merier方法计算生存率,Cox多因素分析影响患者生存情况的危险因素。结果45例HSOS患者,临床表现以腹胀(100%)、腹腔积液(93.3%)、黄疸(71.1%)为主要症状,影像学检查显示,肝脏不同程度肿胀伴肝实质密度不均匀减低(92.1%)与增强扫描门静脉期/延迟期肝实质斑片状和/或“地图状”强化(100%)是HSOS最重要的CT影像学表现。病变区域体积、病变体积与肝脏体积的比值(Ratio)与患者临床严重程度呈正相关。中位随访时间21个月,患者1年生存率为72.5%。多因素Cox分析显示,Ratio(P=0.012)和总胆红素水平(P=0.005)是影响患者生存的主要危险因素。结论吡咯烷生物碱相关肝窦阻塞综合征(PA-HSOS)的影像学表现具有一定特征性,肝脏病变区域体积与临床严重程度正相关,病变区域体积与肝脏体积的比值和总胆红素水平是患者生存的可靠预测因素。

Objective To evaluate the relationship between the volume of liver lesions and the clinical severity and prognosis of pyrrolidine alkaloid-related hepatic sinusoidal obstruction syndrome(PA-HSOS).Methods The clinical data of 45 patients with PA-HSOS(12 with histological confirmation)in our hospital from April 2015 to March 2020 were reviewed.The volume of heterogeneous hypoattenuation on CT was measured and correlated with the clinical severity using one-way analysis of variance.The Kaplan-Meier method was used to calculate the survival rate and the influence of risk factors on survival was determined using multivariate Cox regression analysis.Results The main symptoms were abdominal distension(100%),ascites(93.3%),and jaundice(71.1%).CT findings included varying degrees of liver swelling with heterogeneous reduction of parenchymal density(92.1%)and patchy contrast enhancement in the portal vein and delay phases(100%).The lesion volume and ratio of lesion to liver volumes were positively correlated with the clinical severity.The median follow-up time was 21 months,and the 1-year survival rate was 72.5%.Multivariate Cox analysis showed that the ratio of lesion to liver volumes(P=0.012)and total bilirubin level(P=0.005)were the main risk factors affecting patient survival.Conclusion The volume of liver lesions on CT is positively correlated with the clinical severity.The ratio of lesion to liver volumes and the total bilirubin level are reliable predictors of patient survival in PA-HSOS.