基于多层螺旋CT评估肝硬化门静脉高压症的无创诊断模型

A non-invasive multi-slice spiral CT-based diagnostic model predicts portal hypertension in liver cirrhotic patients

目的研究多层螺旋CT测定肝脏脾脏体积等影像学资料对肝硬化门静脉高压症的无创评估价值。方法筛选2016年9月至2020年12月于上海长征医院住院治疗的肝硬化患者,依据纳入标准和排除标准共纳入88例。根据临床表现推测出的门静脉压力情况,肝硬化患者可分为三组:无门静脉高压组;轻度门静脉高压组(仅有食管胃底静脉曲张或仅有脾功能亢进)和重度门静脉高压组(同时患有食管胃底静脉曲张及脾功能亢进)。应用Add/Remove Structure软件测量全肝体积、脾脏体积等指标,使用血管介入方法测定肝静脉压力梯度(HVPG)。结果肝硬化患者Child-Pugh A、B、C级的患者中,门静脉高压症分布情况并无明显统计学差异。而相关CT参数中肝脏体积在无门静脉高压组[(1075.97±399.90)cm^(3)]、轻度门静脉高压组[(1053.14±281.21)cm^(3)]、重度门静脉高压组[(949.87±229.77)cm^(3)]之间发现,肝脏体积虽可见下降趋势,但无显著统计学差异。而脾脏体积对门静脉高压症患者较好的识别能力,脾脏体积在无门静脉高压组[(397.32±309.49)cm^(3)]、轻度门静脉高压组[(676.55±274.69)cm^(3)]、重度门静脉高压组[(903.80±362.33)cm^(3)]对轻、重度门静脉高压症患者亦有较好的区分能力,ROC曲线下面积均在0.700以上,达0.894。通过多元回归分析的方法,构建门静脉压力的线性评价模型,门静脉压力(mmHg)=-0.08×年龄-1.82×血小板+1.89×CRP-1.71×ln总胆红素+2.06×脾脏体积。诊断模型对门静脉高压症有非常好的诊断价值,ROC曲线下面积高达0.859(95%CI 0.759,0.950),诊断敏感性为80.65%,特异性为55.56%。结论结合血清学指标和影像学参数建立的无创评估模型简便、易行,对门静脉压力具有较好预测价值。

Objective To study on the value of noninvasive evaluation of portal hypertension in patients with liver cirrhosis by morphological characteristics of liver and spleen measured by multi-slice spiral CT.Methods Eighty-eight hospitalized cirrhotic patients in Shanghai Changzheng Hospital from September 2016 to December 2020 were enrolled in this study based on the inclusion and exclusion criteria.Patients with liver cirrhosis were divided into non-portal hypertension group,mild portal hypertension group(with esophagogastric varices or hypersplenism alone)and severe portal hypertension group(with both esophagogastric varices and hypersplenism).Add/Remove Structure software was used to measure the total liver volume and spleen volume.Hepatic venous pressure gradient(HVPG)was measured by vascular intervention method.Results There were no significant differences in the distribution of portal hypertension among Child-Pugh A,B and C patients with liver cirrhosis.There was a descendent trend but no significant differences in the associated CT parameters of liver volume within high portal pressure group[(1075.97±399.90)cm^(3)],and the mild portal pressure group[(1053.14±281.21)cm^(3)],and the severe portal hypertension group[(949.87±229.77)cm^(3)].However,the spleen volume was a good parameter to distinguish patients with portal hypertension.The spleen volume in the non-portal hypertension group was[(397.32±309.49)cm^(3)],in mild portal hypertension group was[(676.55±274.69)cm^(3)],and in severe portal hypertension group was[(903.80±362.33)cm^(3)].For the distinction of patients with mild and severe portal hypertension by spleen volume,the underlying area of the ROC curve was more than 0.700,reaching 0.894.By multi-regression analysis,the linear evaluation model of portal vein pressure was constructed,and portal vein pressure(mmHg)=-0.08×age-1.06×platelet+1.89×CRP-1.71×LN total biliarylin+2.06×spleen volume.This diagnostic model had a very good diagnostic value for portal hypertension,with the ROC curve as high as 0.859(95%CI 0.759,0.950),and a diagnostic sensitivity of 80.65%,and specificity of 55.56%.Conclusion The noninvasive evaluation model established by combining serological indexes and imaging parameters is simple and easy.It has preferable value for predicting portal pressure.