基于多层螺旋CT影像特征原发性肝癌自发性破裂出血危险因素分析

Multi-slice CT imaging features as risk factors in determining spontaneous rupture of primary liver cancer

目的分析原发性肝癌(PLC)自发性破裂出血的CT影像特征,探讨影响原发性肝癌破裂的危险因素。方法将2016年9月至2020年8月宁夏医科大学总医院确诊PLC自发破裂的81例患者纳入病例组,选取同期肿瘤位于肝脏外周而未发生破裂的年龄、性别和巴塞罗那肿瘤分期匹配的81例患者作为对照组。回顾性分析两组患者基础疾病、实验室检验指标以及瘤体位置、分布、大小、形态等CT影像特征的差异,并进行多因素logistic回归分析。结果病例组共纳入81例患者,其中男性72例,女性9例,年龄(53.69±10.34)岁;对照组纳入81例患者,男性64例,女性17例,年龄(54.78±9.04)岁。瘤体CT影像特征中肝硬化、瘤体贴近膈肌、跨叶分布、伴有门静脉阻塞、肿瘤最大径>10 cm、侵犯肝包膜(弓弦比>1)、肿瘤外凸≥25%与PLC自发破裂具有相关性(P<0.05);其中肝硬化(OR=2.796,95%CI:1.721~10.834)、伴门静脉阻塞(OR=3.586,95%CI:1.272~10.107)及肿瘤外凸≥25%(OR=2.831,95%CI:1.668~22.210)可作为PLC自发性破裂的独立预测因子。结论肿瘤外凸≥25%、肝硬化、伴门静脉栓塞与PLC自发性破裂密切相关,可作为预测PLC破裂的独立危险因素。

Objective To analyze the imaging features of spontaneous rupture of primary liver cancer(PLC)and to study the high-risk factors associated with tumor rupture.Methods From September 2016 to August 2020,81 patients who developed spontaneous rupture of PLC at the General Hospital of Ningxia Medical University were included into this study.A control group of 81 patients with tumors located on the periphery of the liver but without rupture treated in the same period were selected by matching the two groups with age,sex and BCLC staging.The clinical data and CT imaging characteristics including tumor location,extent,size,and morphology of the two groups of patients were compared retrospectively between groups.Multivariate logistics regression was used to analyze.Results A total of 81 patients were included in the case group,including 72 males and 9 females,aged(53.69±10.34)years.The control group included 81 patients,64 males and 17 females,aged(54.78±9.04)years.The main risk factors for spontaneous rupture of PLC included in this study were cirrhosis,tumor close to diaphragm,biolobar distribution,portal vein obstruction,tumor diameter>10 cm,invasion of liver capsule(arc-to-chord ratio>1)and tumor protrusion≥25%(P<0.05).Logistic regression analysis showed that cirrhosis(OR=2.796,95%CI:1.721-10.834),portal vein obstruction(OR=3.586,95%CI:1.272-10.107)and tumor protrusion(≥25%)(OR=2.831,95%CI:1.668-22.210)were independent predictive factors of spontaneous rupture of PLC.Conclusion Tumor protrusion≥25%,cirrhosis and portal vein obstruction were closely related to spontaneous rupture of PLC.They were independent risk factors in predicting rupture of primary liver cancer.