基于CT门静脉血管成像的无创模型评估肝硬化门静脉高压患者的食管胃底静脉曲张

A CT portography-based non-invasive model in evaluating gastroesophageal varices in patients with liver cirrhosis and portal hypertension

目的探讨CT门静脉血管成像(CT portography,CTP)指标在评估肝硬化门静脉高压患者食管胃底静脉曲张中的临床应用价值。方法回顾性分析复旦大学附属中山医院2019年4月—2022年3月确诊收治的167名肝硬化患者,根据上消化道内镜检查结果将其分为需要治疗干预的静脉曲张(varices need treatment,VNT)组和非VNT组。对血常规、肝功能、Child-Pugh分级、肝静脉压力梯度和CTP定量参数(包括脾最大横径、胃左静脉直径、门静脉直径、脾静脉直径、肝脏和脾脏体积)进行单因素分析和二元Logistic回归分析,筛选出可以诊断VNT的无创指标,并在此基础上构建诊断模型。通过ROC曲线评价模型的诊断效能,并用DeLong方法比较不同诊断模型的诊断效能。结果单因素和二元Logistic回归分析显示胃左静脉直径和脾体积在VNT分组中差异有统计学意义(P<0.05)。用脾体积与胃左静脉直径的乘积建立诊断模型,当模型截止值>358.69时,其诊断VNT的敏感性为72.99%,特异性为83.33%,ROC曲线下面积为0.799(95%CI:0.730~0.857),其诊断效能优于用血小板计数与脾最大横径的比值(platelet count to spleen diameter ratio,PSDR)诊断模型(P<0.05)。结论应用CTP测得的胃左静脉直径增宽和脾体积增大是肝硬化门静脉高压患者发生VNT的独立危险因素,以二者的乘积建立的无创诊断模型对评估VNT有一定的临床价值。

Objective To explore the clinical value of CT portography(CTP)parameters in evaluating gastroesophageal varices in liver cirrhosis patients with portal hypertension.Methods A retrospective analysis was performed on 167 liver cirrhosis patients diagnosed and treated in Zhongshan Hospital,Fudan University from Apr 2019 to Mar 2022.According to the results of upper gastrointestinal endoscopy,they were divided into groups with varices need treatment(VNT)and non-VNT.The results from routine blood test,liver function,Child-pugh classification,hepatic vein pressure gradient,and quantitative parameters of CTP such as the maximum transverse diameter of spleen,the diameter of left gastric vein,the diameter of portal vein,the diameter of spleen vein,the volume of liver and spleen,were assessed by univariate analysis and binary Logistic regression analysis,and then were used to generate a diagnostic model.The receiver operating characteristic(ROC)curve was used for analysis and the DeLong test was used for comparing different diagnostic models.Results Univariate analysis and binary Logistic regression analysis showed that there were statistically significant differences in spleen volume and left gastric vein diameter between the VNT group and the non-VNT group(P<0.05).Then the model was built by the spleen volume multiplied by left gastric vein diameter(SVLGV).When the cutoff value was greater than 358.69,the sensitivity and specificity of the model in predicting VNT were 72.99%and 83.33%.The area under ROC curve of the SVLGV model was 0.799(95%CI:0.730-0.857),which was superior to the platelet count to spleen diameter ratio(PSDR)model(P<0.05).Conclusion The enlargements of left gastric vein diameter and spleen volume on CTP were independent risk factors for VNT in liver cirrhosis patients with portal hypertension.The non-invasive diagnostic model based on spleen volume and left vein diameter shows a potential clinical value in evaluating VNT.