CT灌注参数与肝细胞癌患者Child-Pugh分级的关系研究

A research on the relevance between Child-Pugh classification and CT perfusion imaging parameters of patients with hepatocellular carcinoma

目的研究CT灌注成像(CTPI)参数与肝细胞癌(HCC)患者Child-Pugh分级的关系。方法纳入2018年3月至2020年3月76例HCC患者作为研究对象,所有患者均接受CTPI检查,记录各参数[肝动脉灌注量(HAP)、门静脉灌注量(PVP)、平均通过时间(MTT)及肝动脉灌注指数(HAPI)]结果,分析CTPI各参数与Child-Pugh分级的关系。结果76例患者中Child-Pugh分级A级38例,B级24例,C级14例。不同Child-Pugh分级患者HAP、PVP、MTT及HAPI水平比较,差异均有统计学意义(P<0.05)。其中C级患者HAP、HAPI显著高于A级、B级,PVP和MTT显著低于A级患者,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,HAP、HAPI等CTPI参数与Child-pugh分级呈显著正相关性(P<0.05),MTT和PVP与Child-pugh分级呈显著负相关性(P<0.05)。受试者操作特征曲线(ROC)分析显示HAP(AUC=0.727,95%CI=0.562~0.892,P=0.013)、PVP(AUC=0.703,95%CI=0.574~0.832,P=0.026)、MTT(AUC=0.747,95%CI=0.601~0.894,P=0.007)、HAPI(AUC=0.694,95%CI=0.506~0.882,P=0.034)对判断Child-Pugh C级均具有一定价值,联合预测概率判断Child Pugh C级的AUC为0.815(95%CI=0.689~0.942,P=0.001)。结论CTPI参数与HCC患者Child-Pugh分级密切相关,CTPI参数有助于判断Child-Pugh分级,为临床干预提供依据。

Objective To study on the relationship between Computed Tomography perfusion imaging(CTPI)parameters and Child-Pugh classification in patients with hepatocellular carcinoma(HCC).Methods Seventy-six patients with HCC from March 2018 to March 2020 were included as the research objects.All patients underwent CTPI,parameters including hepatic arterial perfusion(HAP),portal venous perfusion(PVP),mean transit time(MTT),hepatic arterial perfusion index(HAPI)were recorded.The relationship between these CTPI parameters and Child-pugh grades of the patients was analyzed.Results In these 76 patients,there were 38 cases with Child-pugh grade A,24 cases with grade B,and 14 cases with grade C.Significant differences were found in the levels of HAP,PVP,MTT and HAPI in patients with different Child-pugh grades(P<0.05).The HAP and HAPI of grade C patients were significantly higher than those of Grade A and B,while the PVP and MTT were significantly lower than those of Grade A(P<0.05).The Pearson correlation analysis showed that the CTPI parameters such as the HAP and HAPI were positively correlated with child Pugh classification(P<0.05),whereas MTT and PVP were negatively correlated with child Pugh grades(P<0.05).The receiver operator characteristic curve(ROC)analysis showed that the HAP(AUC=0.727,95%CI=0.562-0.892,P=0.013),PVP(AUC=0.703,95%CI=0.574-0.832,P=0.026),MTT(AUC=0.747,95%CI=0.601-0.894,P=0.007),HAPI(AUC=0.694,95%CI=0.506-0.882,P=0.034)had certain value in judging Child-pugh grade C.The AUC of joint probability to predict Child-pugh C was 0.815(95%CI=0.689-0.942,P=0.001).Conclusion The CTPI parameters are closely related to Child-pugh classification in HCC patients.CTPI parameters are helpful to predict the Child-pugh classification and provide a basis for clinical intervention.