CT门静脉成像参数评估乙型肝炎肝硬化患者肝功能分级及EVB风险的价值

摘要/Abstract

摘要： 目的分析电子计算机断层扫描(CT)门静脉成像参数评估肝功能分级以及食管静脉曲张破裂出血(EVB)风险的临床价值。方法选取2020年1月至2023年6月运城市中心医院收治的乙型肝炎肝硬化患者60例,其中消化道出血组31例,非出血组29例;另选同期健康者54名为对照组。使用CT门静脉成像测量两组患者门静脉主干(MPV)、脾静脉(SPV)、胃左静脉(LGV)、肝内门静脉左支(IHLPV)、肝内门静脉右支(IHRPV)。比较不同Child-Pugh分级患者,以及消化道出血组与非出血组患者门脾静脉各血管直径。ROC分析门脾静脉各血管直径预测乙型肝炎肝硬化患者发生EVB的价值。结果乙型肝炎肝硬化组MPV、LGV、SPV、IHRPV、IHLPV直径分别为(1.8±0.5)cm、(1.5±0.4)cm、(1.4±0.3)cm、(1.4±0.4)cm、(1.2±0.3)cm,均高于对照组的(1.1±0.2)cm、(0.6±0.1)cm、(0.8±0.2)cm、(0.7±0.2)cm、(0.6±0.2)cm。Child-Pugh A级MPV、LGV、SPV、IHRPV、IHLPV直径分别为(1.9±0.4)cm、(1.6±0.4)cm、(1.5±0.4)cm、(1.4±0.4)cm、(1.3±0.4)cm,均显著低于Child-Pugh B级的(2.5±0.5)cm、(1.9±0.3)cm、(1.8±0.5)cm、(1.8±0.6)cm、(1.8±0.4)cm,Child-Pugh B级均显著低于Child-Pugh C级的(2.7±0.7)cm、(2.3±0.6)cm、(2.2±0.6)cm、(2.2±0.7)cm、(2.2±0.7)cm,差异均有统计学意义(P<0.05)。消化道出血组IHRPV直径为(1.6±0.4)cm,非出血组为(1.5±0.3)cm,差异无统计学意义(P>0.05);消化道出血组MPV、LGV、SPV、IHLPV直径分别为(2.4±0.7)cm、(2.1±0.5)cm、(1.7±0.5)cm、(1.7±0.4)cm,均高于对照组的(1.6±0.4)cm、(1.2±0.3)cm、(1.3±0.3)cm、(1.1±0.1)cm(P<0.05)。经ROC分析证实门脾静脉各血管直径能预测乙型肝炎肝硬化患者发生EVB,曲线下面积为0.815、0.841、0.829、0.813(均P<0.05)。结论 CT门静脉成像可清晰反映乙型肝炎肝硬化患者门静脉高压侧支循环血管情况,同时其主干及属支直径对预测EVB发生具有临床价值。

关键词: CT门静脉成像, 乙型肝炎肝硬化, 肝功能分级, 食管静脉曲张破裂出血

Abstract: Objective To analyze the clinical value of computer tomography (CT) portal vein imaging parameters in evaluating liver function classification and esophageal variceal bleeding (EVB) risk in hepatitis B patients with cirrhosis. Methods From January 2020 to June 2023, sixty hepatitis B patients with cirrhosis were selected as the cirrhotic group(31 patients with gastrointestinal bleeding and 29 patients without bleeding). Fifty-four healthy people were selected in the same time period as the control group. CT portal vein imaging was used to measure the main portal vein (MPV), splenic vein (SPV), left gastric vein (LGV), left intrahepatic portal vein (IHLPV), and right intrahepatic portal vein (IHRPV) in the two groups; The diameters of portal and splenic veins with different Child Pugh grades in the cirrhotic patients were compared; The diameters of portal and splenic veins in the cirrhotic patients of gastrointestinal bleeding group and non-bleeding group were compared; The value of the diameters of portal and splenic veins in predicting EVB in cirrhotic patients were analyzed by reciever operating characteristic curve (ROC) method. Results The diameters of MPV, LGV, SPV, IHRPV and IHLPV in the hepatitis B cirrhosis group were (1.8 ± 0.5) cm, (1.5 ± 0.4) cm, (1.4 ± 0.3) cm, (1.4 ± 0.4) cm and (1.2 ± 0.3) cm, respectively, which were significantly higher than those in the control group [(1.1 ± 0.2) cm, (0.6 ± 0.1) cm, (0.8 ± 0.2) cm, (0.7 ± 0.2) cm and (0.6 ± 0.2) cm, respectively, P<0.05]; The diameters of MPV, LGV, SPV, IHRPV and IHLPV in Child-Pugh grade A patients were (1.9 ± 0.4) cm, (1.6 ± 0.4) cm, (1.5 ± 0.4) cm, (1.4 ± 0.4) cm and (1.3 ± 0.4) cm, respectively, which were significantly lower than those of [(2.5 ± 0.5) cm, (1.9 ± 0.3) cm, (1.8 ± 0.5) cm, (1.8 ± 0.6) cm and (1.8 ± 0.4) cm, P<0.05] in Child-Pugh grade B patients. and those of [(2.7 ± 0.7) cm, (2.3 ± 0.6) cm, (2.2 ± 0.6) cm, (2.2 ± 0.7) cm, (2.2 ± 0.7) cm in Child-Pugh C,patients [ P<0.05]; The diameter of IHRPV in the gastrointestinal bleeding group [(1.6 ± 0.4) cm] was significantly higher than that in the non-bleeding group [(1.5 ± 0.3) cm] (P>0.05). The diameters of MPV, LGV, SPV and IHLPV in the gastrointestinal bleeding group were (2.4 ± 0.7) cm, (2.1 ± 0.5) cm, (1.7 ± 0.5) cm and (1.7 ± 0.4) cm, respectively, which were significantly higher than those of (1.6 ± 0.4) cm, (1.2 ± 0.3) cm, (1.3 ± 0.3) cm and (1.1 ± 0.5) cm in the control group (P<0.05); ROC analysis confirmed that the diameters of portal and splenic veins could predict the occurrence of EVB in patients with hepatitis B cirrhosis, and the areas under the curves (AUC) of MPV, LGV, SPV and IHLPV were 0.815, 0.841, 0.829, 0.813, respectively, with all P<0.05. Conclusion CT portal vein imaging can clearly reflect the collateral circulation of portal hypertension in hepatitis B patients with cirrhosis, and the diameters of its trunks and branches has clinical value in predicting the occurrence of EVB.

Key words: CT portal vein imaging, Hepatitis B related cirrhosis, Liver function grading, Rupture and bleeding of esophageal varices

黄亚博, 杨莹, 王晋君. CT门静脉成像参数评估乙型肝炎肝硬化患者肝功能分级及EVB风险的价值[J]. 肝脏, 2024, 29(2): 162-165.

HUANG Ya-bo, YANG Ying, WANG Jin-jun. The value of portal vein imaging parameters of computer tomography in evaluating liver function grading and esophageal variceal bleeding risk in hepatitis B patients with cirrhosis[J]. Chinese Hepatolgy, 2024, 29(2): 162-165.

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