CT平扫测量食管壁厚度与胃镜下红色征的相关性

Correlation between esophageal wall thickness on CT plain scan and red color sign on endoscopy in patients with liver cirrhosis: a cross-sectional study

目的 分析内镜下红色征与食管壁厚度的关系,以无创预测肝硬化食管静脉曲张破裂出血。方法 收集2019年1月至2022年5月在邢台市人民医院同时行内镜及CT平扫检查的125例乙型肝炎肝硬化患者。根据有无红色征将研究对象分为有红色征组和无红色征组。比较有红色征组与无红色征组的临床特征。采用logistic回归分析与红色征相关的变量。采用受试者工作特征曲线评价食管壁厚度的诊断效果。结果 125例患者中无红色征84例,有红色征41例。有红色征组患者血小板、血清白蛋白分别为75(46,93)×10^(9)/L、(34.45±4.49)g/L,均低于无红色征组的97(73,148)×10^(9)/L、(37.44±6.25)g/L,差异有统计学意义(P<0.05);凝血酶原时间、国际标准化比值、Child-Pugh评分在红色征组分别为14.0(12.5,16.6)s、1.28(1.15,1.46)、8(7,9),均高于无红色征组,12.5(11.4,15.1)s、1.15(1.04,1.31)、7(6,8),差异有统计学意义(P<0.05)。红色征组腹水的发生率为48.8%高于无红色征组的29.7%。红色征组食管壁增厚明显(Z=-6.663,P<0.001)。多因素回归分析表明,食管壁增厚是红色征的独立危险因素(HR=1.405,95%CI:1.203~1.64,P<0.001)。诊断食管壁厚度的ROC曲线下面积为0.868 (95%CI:0.804~0.931,P<0.001),截断值为7.14 mm。结论 食管壁增厚可作为红色征的参考指标,为临床筛查食管静脉曲张出血提供分层指标。

Objective To analyze the correlation between esophageal wall thickness(EWT)measured by CT plain scan and the red colour sign(RCS)observed during endoscopy,aiming to predict esophageal variceal bleeding in patients with cirrhosis.Methods A total of 125 patients with hepatitis B cirrhosis who underwent endoscopy and CT plain scans at Xingtai People's Hospital from January 2019 to May 2022 were enrolled in this study.The subjects were divided into two groups based on the presence or absence of the RCS:the RCS-positive group and the RCS-negative group.The clinical characteristics of patients in both groups were compared.Logistic regression analysis was performed to identify variables related to RCS.The diagnostic efficacy of EWT was assessed using the receiver operating characteristic(ROC)curve,and the Youden index was utilized to determine the cut-off value.Results The stufy included 125 patients,consisting of 86 males and 39 females,with a mean age of 53.6±11.7 years.Among them,84 patients did not present with the RCS,while 41 did.The platelet and serum albumin values in patients with RCS were 75(45.75-93.5)×10^(9)/L,and 34.45±4.49 g/L,respectively,which were significantly lower than those in patients without RCS,97(73-148)×10^(9)/L and 37.44±6.25 g/L,(P<0.05).Prothrombin time,international normalized ratio and Child-Pugh score in the RCS-positive group were 14.0(12.5-16.6)s,1.28(1.15-1.46),and 8(7-9),respectively,which were significantly higher than those in the RCS-negative group,12.5(11.4,15.1)s,1.15(1.04,1.31),and 7(6,8)(P<0.05).The incidence of ascites was also higher in the RCS-postive group(25(29.7%)vs20(48.8%)).EWT was significantly higher in patients with RCS(Z=-6.663,P=0.000).Multivariate regression analysis identified EWT as an independent risk factor for RCS(HR=1.405;95%CI:1.203-1.64,P=0.000).The area under the curve(AUC)for diagnosing RCs based on EWT was 0.868(95%CI:0.804-0.931,P=0.000),with a cut off value of 7.14 mm.Conclusion EWT can be used as a screening index for RCS and provide a stratified index for clinical screening of esophageal varices bleeding.