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

肝脏 ›› 2021, Vol. 26 ›› Issue (11): 1240-1245.

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

王剑, 时培美, 沈杰, 魏珏

200003 上海海军军医大学附属长征医院消化内科(王剑,时培美);上海市同仁医院消化内科(魏珏) ;上海交通大学附属第一人民医院消化内科(沈杰)

收稿日期:2021-09-18 出版日期:2021-11-30 发布日期:2021-12-24
通讯作者: 魏珏,Email:weijuemd@shsmu.edu.cn;沈杰,Email:shenjiemd@163.com
基金资助:
上海市卫生和计划生育委员会科研项目(面上)(201840233);上海市科委自然科学基金项目(面上)(21ZR1458700)

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

WANG Jian¹, SHI Pei-mei¹, SHEN Jie², WEI Yu³

1. Department of Gastroenterology, Changzheng Hospital, Naval Medical University;
2. Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200085, China;
3. Department of Gastroenterology, Shanghai Tongren Hospital, Jiaotong University of Medicine, Shanghai 200336, China

Received:2021-09-18 Online:2021-11-30 Published:2021-12-24
Contact: WEI Yu, Email: weijuemd@shsmu.edu.cn; SHEN Jie, Email: shenjiemd@163.com

摘要/Abstract

摘要： 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[(1 075.97±399.90) cm³]、轻度门静脉高压组[(1 053.14±281.21) cm³]、重度门静脉高压组[(949.87±229.77) cm³]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) cm³]、轻度门静脉高压组[(676.55±274.69) cm³]、重度门静脉高压组[(903.80±362.33) cm³]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。

关键词: 门静脉高压症, 多层螺旋CT, 全肝体积, 脾脏体积, 诊断

Abstract: 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) cm³], and the mild portal pressure group [(1053.14±281.21) cm³], and the severe portal hypertension group[(949.87±229.77) cm³]. 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) cm³], in mild portal hypertension group was[(676.55±274.69) cm³], and in severe portal hypertension group was[(903.80±362.33) cm³]. 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.

Key words: Portal hypertension, multi-layer spiral CT, full liver volume, spleen volume, diagnosis

王剑, 时培美, 沈杰, 魏珏. 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[J]. 肝脏, 2021, 26(11): 1240-1245.

WANG Jian, SHI Pei-mei, SHEN Jie, WEI Yu. A non-invasive multi-slice spiral CT-based diagnostic model predicts portal hypertension in liver cirrhotic patients[J]. Chinese Hepatolgy, 2021, 26(11): 1240-1245.

参考文献

[1] Germani G, Hytiroglou P, Fotiadu A, et al. Assessment of fibrosis and cirrhosis in liver biopsies: an update. Semin Liver Dis,2011,31:82-90.
[2] Hernandez-Gea V, Friedman SL. Pathogenesis of liver fibrosis. Annu Rev Pathol, 2011,6:425-456.
[3] Berzigotti A, Seijo S, Reverter E, et al. Assessing portal hypertension in liver diseases. Expert Rev Gastroenterol Hepatol,2013,7:141-155.
[4] Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet,2014,383:1749-1761.
[5] De Franchis R, Baveno VF. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol,2010,53:762-768.
[6] Groszmann R, Vorobioff JD, Gao H. Measurement of portal pressure: when, how, and why to do it. Clin Liver Dis,2006,10:499-512, viii.
[7] Zardi EM, Di Matteo FM, Pacella CM, et al. Invasive and non-invasive techniques for detecting portal hypertension and predicting variceal bleeding in cirrhosis: a review. Ann Med, 2014,46:8-17.
[8] Qi X, Li Z, Huang J, et al. Virtual portal pressure gradient from anatomic CT angiography. Gut, 2015,64:1004-1005.
[9] Park SH, Park TE, Kim YM, et al. Non-invasive model predicting clinically-significant portal hypertension in patients with advanced fibrosis. J Gastroenterol Hepatol,2009,24:1289-1293.
[10] Buck M, Garcia-Tsao G, Groszmann RJ, et al. Novel inflammatory biomarkers of portal pressure in compensated cirrhosis patients. Hepatology,2014,59:1052-1059.
[11] Singal AK, Ahmad M, Soloway RD. Duplex Doppler ultrasound examination of the portal venous system: an emerging novel technique for the estimation of portal vein pressure. Dig Dis Sci,2010,55:1230-1240.
[12] Shi KQ, Fan YC, Pan ZZ, et al. Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease. Liver Int,2013,33:62-71.
[13] Sharma P, Kirnake V, Tyagi P, et al. Spleen stiffness in patients with cirrhosis in predicting esophageal varices. Am J Gastroenterol,2013,108:1101-1107.
[14] Hayashi H, Beppu T, Okabe H, et al. Combined measurements of serum bile acid level and splenic volume may be useful to noninvasively assess portal venous pressure. J Gastroenterol, 2012,47:1336-1341.
[15] Iranmanesh P, Vazquez O, Terraz S, et al. Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma. J Hepatol,2014,60:969-974.