MSCT测量门静脉系统相关指标在肝硬化门静脉高压症诊断中的应用

摘要/Abstract

摘要： 目的探讨门静脉系统相关指标在肝硬化门静脉高压症诊断中的应用价值。方法选取2020年7月至2023年7月淮安市第一医院治疗的100例肝硬化门静脉高压症患者,其中肝功能分级A级39例,B级34例,C级27例。另选同期进行体检的95名健康者。均进行多层螺旋CT(MSCT)检查,比较两组门静脉系统相关指标包括门静脉主干(MPV)、脾静脉(SPV)、肝内门静脉左支(IHLPV)、肝内门静脉右支(IHRPV),比较不同肝功能分级患者门静脉系统相关指标。应用受试者工作特征曲线下面积(AUC)评估门静脉系统相关指标诊断肝硬化门静脉高压症的价值。结果肝硬化组MPV、SPV、IHLPV、IHRPV直径分别为(18.42±4.21)mm、(14.53±3.61)mm、(13.52±3.27)mm、(13.87±3.52)mm,均高于健康对照组的(11.37±2.70)mm、(9.23±1.88)mm、(9.16±1.62)mm、(9.25±1.62)mm,差异均有统计学意义(P<0.05)。肝功能C级患者MPV、SPV、IHLPV、IHRPV直径分别为(21.15±3.83)mm、(16.49±3.05)mm、(16.07±3.12)mm、(16.11±3.25)mm,高于肝功能B级患者的(18.19±3.02)mm、(15.01±2.54)mm、(14.58±2.95)mm、(14.57±3.03)mm,肝功能B级患者MPV、SPV、IHLPV、IHRPV高于肝功能A级患者的(16.57±2.31)mm、(13.37±2.03)mm、(13.15±2.55)mm、(13.16±2.74)mm,差异均有统计学意义(P<0.05)。以MPV≥13.68 mm、SPV≥11.32 mm、IHLPV≥11.75 mm、IHRPV≥10.9 mm为截断点,MPV、SPV、IHLPV、IHRPV诊断肝硬化门静脉高压症的曲线下面积分别为0.801(95% CI:0.707~0.894)、0.702(95% CI:0.587~0.817)、0.806(95% CI:0.705~0.907)、0.813(95% CI:0.720~0.906);经一致性分析证实,MSCT测量门静脉系统相关指标诊断肝硬化门静脉高压症的准确率96.00%、灵敏度96.74%、特异度87.50%、阳性预测值98.89%、阴性预测值70.00%、Kappa值=0.756。结论门静脉系统相关指标用于诊断肝硬化门静脉高压症具有较高的准确率、灵敏度及特异度,可为临床诊治提供依据。

关键词: 多层螺旋CT, 门静脉系统, 肝硬化, 门静脉高压症, 肝功能

Abstract: Objective To investigate the application value of multi-slice spiral CT (MSCT) in the diagnosis of portal hypertension in liver cirrhosis. Methods A total of 100 cirrhotic patients with portal hypertension who were treated in our hospital between July 2020 and July 2023 were selected as the observation group. Ninety-five healthy people who underwent physical examination in our hospital during the same period of time were selected as the control group. MSCT examination was performed in all patients. The related indexes of portal vein system [main portal vein (MPV), splenic vein (SPV), left branch of intrahepatic portal vein (IHLPV), right branch of intrahepatic portal vein (IHRPV)] of the two groups, and the related indexes of portal vein system of patients with different liver function grades were compared. The values of using portovenous system-related indicators in the diagnosis of portal hypertension in cirrhotic patients were analyzed by receiver operating characteristic (ROC) curve consistency method. Results The MPV, SPV, IHLPV and IHRPV in the observation group were [(18.42±4.21) mm, (14.53±3.61) mm, (13.52±3.27) mm, (13.87±3.52) mm], respectively, which were higher than those of [(11.37±2.70) mm, (9.23±1.88) mm, (9.16±1.62) mm, (9.25±1.62) mm] in the control group (P<0.05); The diameters of MPV, SPV, IHLPV and IHRPV in grade C patients were [(21.15±3.83) mm, (16.49±3.05) mm, (16.07±3.12) mm, (16.11±3.25) mm], respectively, which were higher than those of [(18.19±3.02) mm, (15) .01±2.54] mm, (14.58±2.95) mm, (14.57±3.03) mm] in grade B patients. These parameters in patients with liver function grade B were higher than those of [(16.57±2.31) mm, (13.37±2.03) mm, (13.15±2.55) mm, (13.16±2.74) mm] in patients with liver function grade A (P<0.05). With MPV≥13.68 mm, SPV≥11.32 mm, IHLPV≥11.75mm and IHRPV≥10.9 mm as cut-off points, the areas under the curve (AUC) of MPV, SPV, IHLPV and IHRPV for the diagnosis of portal hypertension in cirrhosis was 0.801 (95%CI: 0.707~0.894), 0.702 (95%CI: 0.587~0.817), 0.806 (95%CI: 0.705~0.907), and 0.813 (95%CI: 0.720~0.906), with all P<0.05; By consistency analysis it was confirmed that the accuracy of MSCT measurement of portal vein system related indicators in the diagnosis of portal hypertension in cirrhosis was 96.00%, with a sensitivity of 96.74%, specificity of 87.50%, positive predictive value of 98.89%, negative predictive value of 70.00%, Kappa value =0.756. Conclusion MSCT measurement of portal vein system-related indicators for the diagnosis of cirrhosis portal hypertension has high accuracy, sensitivity and specificity, which is conducive not only to reducing the occurrence of missed diagnosis and misdiagnosis, but also to dynamically monitoring of patients' conditions, The detection operation method is non-invasive and convenient, which can provide reliable basis for clinical diagnosis and treatment, with high promotion value.

Key words: Multislice spiral CT, Portal vein system, Liver cirrhosis, Portal hypertension, Liver function

陈凯, 张方方, 葛尚. MSCT测量门静脉系统相关指标在肝硬化门静脉高压症诊断中的应用[J]. 肝脏, 2024, 29(11): 1330-1333.

CHEN Kai, ZHANG Fang-fang, GE Shang. The application of multi-slice spiral CT measurement of portal vein system-related indicators in the diagnosis of portal hypertension in liver cirrhotic patients[J]. Chinese Hepatolgy, 2024, 29(11): 1330-1333.

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