CAJ | 학술논문

目的：评价64层螺旋 CT 门静脉造影在肝硬化患者肝功能分级和食管静脉曲张破裂出血（EVB）预测中的临床价值。方法使用64层螺旋 CT 对64例肝硬化患者（消化道出血组30例、非出血组34例）及36例正常对照人群门静脉主干（MPV）、脾静脉（SPV）、胃左静脉（LGV）、肝内门静脉左支（IHLPV）和肝内门静脉右支（IHRPV）进行测量；应用受试者工作特征曲线下面积（AUC）评价上述各指标预测 EVB 的价值。结果肝硬化患者 MPV、SPV、LGV、IHLPV 和 IHRPV 直径分别为（1.68±0.21）cm、（1.45±0.18）cm、（0.53±0.12）cm、（1.21±0.15）cm 和（1.26±0.22）cm，显著高于对照组[分别为（1.18±0.14）cm、（0.80±0.09）cm、（0.42±0.07）cm、（0.95±0.07）cm 和（0.96±0.11）cm，P＜0.05]；Child-Pugh C 级患者 MPV、SPV、LGV、IHLPV 和 IHRPV 直径分别为（2.01±0.20）cm、（1.57±0.10）cm、（0.59±0.11）cm、（1.36±0.09）cm 和（1.45±0.12）cm，显著高于 Child-Pugh A 级患者[分别为（1.68±0.15） cm、（1.35±0.13）cm、（0.48±0.09）cm、（1.11±0.13）cm 和（1.15±0.21）cm，P＜0.05]；消化道出血患者 MPV、SPV、LGV 和 IHLPV 直径分别为（1.78±0.16）cm、（1.54±0.20）cm、（0.62±0.10）cm 和（1.28±0.15）cm，显著高于非出血患者[分别为（1.60±0.21）cm、（1.36±0.13）cm、（0.45±0.06）cm 和（1.15±0.13）cm，P＜0.05]；出血患者 IHRPV 直径[（1.29±0.21）cm]与非出血患者[（1.25±0.23）cm]差异无统计学意义；LGV 的 AUC 为0.906。当 LGV＞0.61 cm 时，预测 EVB 的敏感度为93.3%，特异度为58.8%。结论64层螺旋 CT 门静脉造影能够清晰显示肝硬化门静脉高压侧支循环血管情况，并对预测 EVB 具有一定的临床应用价值。
목적：평개64층라선 CT 문정맥조영재간경화환자간공능분급화식관정맥곡장파렬출혈（EVB）예측중적림상개치。방법사용64층라선 CT 대64례간경화환자（소화도출혈조30례、비출혈조34례）급36례정상대조인군문정맥주간（MPV）、비정맥（SPV）、위좌정맥（LGV）、간내문정맥좌지（IHLPV）화간내문정맥우지（IHRPV）진행측량；응용수시자공작특정곡선하면적（AUC）평개상술각지표예측 EVB 적개치。결과간경화환자 MPV、SPV、LGV、IHLPV 화 IHRPV 직경분별위（1.68±0.21）cm、（1.45±0.18）cm、（0.53±0.12）cm、（1.21±0.15）cm 화（1.26±0.22）cm，현저고우대조조[분별위（1.18±0.14）cm、（0.80±0.09）cm、（0.42±0.07）cm、（0.95±0.07）cm 화（0.96±0.11）cm，P＜0.05]；Child-Pugh C 급환자 MPV、SPV、LGV、IHLPV 화 IHRPV 직경분별위（2.01±0.20）cm、（1.57±0.10）cm、（0.59±0.11）cm、（1.36±0.09）cm 화（1.45±0.12）cm，현저고우 Child-Pugh A 급환자[분별위（1.68±0.15） cm、（1.35±0.13）cm、（0.48±0.09）cm、（1.11±0.13）cm 화（1.15±0.21）cm，P＜0.05]；소화도출혈환자 MPV、SPV、LGV 화 IHLPV 직경분별위（1.78±0.16）cm、（1.54±0.20）cm、（0.62±0.10）cm 화（1.28±0.15）cm，현저고우비출혈환자[분별위（1.60±0.21）cm、（1.36±0.13）cm、（0.45±0.06）cm 화（1.15±0.13）cm，P＜0.05]；출혈환자 IHRPV 직경[（1.29±0.21）cm]여비출혈환자[（1.25±0.23）cm]차이무통계학의의；LGV 적 AUC 위0.906。당 LGV＞0.61 cm 시，예측 EVB 적민감도위93.3%，특이도위58.8%。결론64층라선 CT 문정맥조영능구청석현시간경화문정맥고압측지순배혈관정황，병대예측 EVB 구유일정적림상응용개치。
Objective To assess the clinical value of 64-slice spiral CT portography in prediction of esophageal variceal bleeding(EVB) in cirrhotic patients. Methods Sixty four patients with liver cirrhosis(30 cases with EVB, and 34 without) and 36 normal persons underwent 64-slice spiral CT portography and the diameters of the main portal vein (MPV),splenic vein (SPV),left gastric vein (LGV),intrahepatic left portal vein (IHLPV) and intrahepatic right portal vein(IHRPV) were measured; The ability of these indexes in prediction of EVB were evaluated by the area under the receiver operating characteristic (ROC) curves (AUC). Results The diameters of MPV,SPV,LGV,IHLPV and IHRPV in cirrhotic patients were (1.68±0.21) cm,(45±0.18) cm,(0.53±0.12) cm,(1.21±0.15) cm and(1.26±0.22) cm,respectively, significantly higher than those in the controls[(1.18±0.14) cm,(0.80 ±0.09) cm,(0.42 ±0.07) cm,(0.95 ±0.07) cm and (0.96 ±0.11) cm,respectively,P <0.05];The diameters of MPV,SPV,LGV,IHLPV and IHRPV in patients with Child-Pugh class C were(2.01±0.20)cm,(1.57± 0.10) cm,(0.59±0.11)cm,(1.36±0.09) cm and (1.45±0.12) cm,respectively,significantly higher than those in patients with Child-Pugh class A[(1.68±0.15)cm,(1.35±0.13)cm,(0.48±0.09)cm,(1.11±0.13)cm and(1.15±0.21) cm,respectively,P<0.05];The diameters of MPV,SPV,LGV and IHLPV in EVB group were (1.78±0.16) cm,(1.54±0.20)cm,(0.62±0.10)cm and(1.28±0.15)cm,respectively,significantly higher than those in patients without EVB[(1.60±0.21)cm,(1.36±0.13)cm,(0.45±0.06)cm and(1.15±0.13)cm,respectively,P<0.05];The diameter of IHRPV showed no difference between patients with EVB (1.29±0.21)cm and without EVB (1.25±0.23)cm;The AUC of LGV was 0.906,and the sensitivity and specificity in prediction of EVB were 93.3% and 58.8% , respectively when LGV was greater than 0.61 cm. Conclusion 64-slice spiral CT portal venography can not only clearly show the collateral vessels of portal hypertension in cirrhotic patients,but also has a certain value in prediction of EVB in clinical practice.