CT诊断肝硬化食管胃静脉曲张的价值分析
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摘要
目的对CT诊断肝硬化食管胃静脉曲张的临床价值进行分析。方法对本院2015年4月～2018年6月收治的肝硬化患者155例进行回顾性分析,根据消化道是否出血进行分组。其中有80例患者入院时有消化道出血现象,纳为出血组;其余75例患者为消化道未出血者,纳为未出血组。将两组患者的CTP(CT门静脉成像)结果与胃镜检查结果进行比较,并采用Kappa进行检验分析,采用ROC曲线对CTP参数门静脉主干(MPV)、脾静脉(SPV)和胃左静脉(LGV)直径预测食管胃静脉曲张破裂出血的准确性。结果 155例肝硬化患者中,CTP检查显示食管胃静脉曲张阴性31例、阳性124例;胃镜检查显示阴性33例,阳性122例。CTP检查发现有5例胃-肾分流和3例脾-肾分流。Kappa一致性显示CTP检查和胃镜检查具有较高的一致性,k值分别为0.798和0.775,P <0.01;出血组MPV、SPV、LGV直径宽于未出血组,差异有统计学意义(P <0.05)。MPV和LGV直径预测食管胃静脉曲张破裂出血均有一定的准确性,LGV直径准确性更高,以6.1mm为界值,其敏感性和特异性分别为65.71%和84.93%;MPV直径以16.3mm为界值时,敏感性(75.71%)优于LGV和SPV直径。结论 CTP能够准确判断肝硬化食管静脉曲张的分型、分级,与胃镜检查具有较高的一致性,具有无创性、清晰性等优势,可用作临床诊断的依据,指导临床诊断和治疗。
Objective To analyze the clinical value of CT in diagnosis of esophageal gastric varices in liver cirrhosis.Methods One hundred and fifty-five patients with liver cirrhosis who were admitted to our hospital from April 2015 to June 2018 were a retrospectively analyzed.They were divided into two groups according to whether the digestive tract was bleeding or not.Among them,80 patients had gastrointestinal bleeding on admission and they were selected in the bleeding group.The remaining 75 patients had no gastrointestinal bleeding and they were selected in the non-bleeding group.The CTP(CT portography)results of the two groups were compared with the results of gastroscopy,and the test was performed using kappa.The accuracy of esophageal varices bleeding was predicted by ROC curve on the diameter of main portal vein(MPV),splenic vein(SPV)and left gastric vein(LGV)of CTP parameters. Results Among the 155 patients with liver cirrhosis,CTP examination showed there were 31 negative cases and 124 positive cases of esophageal and gastric varices.Gastroscopy showed 33 negative cases and 122 positive cases.CTP revealed gastric-kidney shunt in 5 cases and spleen-kidney shunt in 3 cases.Kappa consistency showed a high consistency between CTP and gastroscopy,with k values of 0.798 and 0.775,respectively,P < 0.01.The diameters of MPV,SPV and LGV in the bleeding group were wider than those in the non-bleeding group,and the difference was statistically significant(P < 0.05).MPV and LGV diameters had certain accuracy in predicting esophageal varices bleeding,but the accuracy of LGV diameter was higher.The sensitivity and specificity were respectively 65.71% and 84.93%,with 6.1 mm as the critical value.When MPV diameter was with 16.3 mm as the critical value,its sensitivity(75.71%)was superior to that of LGV diameter and SPV diameter. Conclusion CTP can accurately determine the classification and grading of esophageal varices in liver cirrhosis and it has a high consistency with gastroscopy.It has the advantages of non-invasiveness and clarity,which can be used as a basis for clinical diagnosis to guide clinical diagnosis and treatment.
Objective To analyze the clinical value of CT in diagnosis of esophageal gastric varices in liver cirrhosis.Methods One hundred and fifty-five patients with liver cirrhosis who were admitted to our hospital from April 2015 to June 2018 were a retrospectively analyzed.They were divided into two groups according to whether the digestive tract was bleeding or not.Among them,80 patients had gastrointestinal bleeding on admission and they were selected in the bleeding group.The remaining 75 patients had no gastrointestinal bleeding and they were selected in the non-bleeding group.The CTP(CT portography)results of the two groups were compared with the results of gastroscopy,and the test was performed using kappa.The accuracy of esophageal varices bleeding was predicted by ROC curve on the diameter of main portal vein(MPV),splenic vein(SPV)and left gastric vein(LGV)of CTP parameters. Results Among the 155 patients with liver cirrhosis,CTP examination showed there were 31 negative cases and 124 positive cases of esophageal and gastric varices.Gastroscopy showed 33 negative cases and 122 positive cases.CTP revealed gastric-kidney shunt in 5 cases and spleen-kidney shunt in 3 cases.Kappa consistency showed a high consistency between CTP and gastroscopy,with k values of 0.798 and 0.775,respectively,P < 0.01.The diameters of MPV,SPV and LGV in the bleeding group were wider than those in the non-bleeding group,and the difference was statistically significant(P < 0.05).MPV and LGV diameters had certain accuracy in predicting esophageal varices bleeding,but the accuracy of LGV diameter was higher.The sensitivity and specificity were respectively 65.71% and 84.93%,with 6.1 mm as the critical value.When MPV diameter was with 16.3 mm as the critical value,its sensitivity(75.71%)was superior to that of LGV diameter and SPV diameter. Conclusion CTP can accurately determine the classification and grading of esophageal varices in liver cirrhosis and it has a high consistency with gastroscopy.It has the advantages of non-invasiveness and clarity,which can be used as a basis for clinical diagnosis to guide clinical diagnosis and treatment.
引文
[1]Rahimi RS,Rockey DC.End-stage liver disease complications[J].Curr Opin Gastroenterol,2013,29(3):257-263.
[2]Kiyosue H,Ibukuro K,Maruno M,et al.Multidetector CTanatomy of drainage routes of gastric varices:a pictorialreview[J].Radiographics,2013,33(1):87-100.
[3]刘桂勤,华静,沈加林.CT门静脉血管成像预测肝硬化门静脉高压食管胃底静脉曲张破裂出血价值[J].中华实用诊断与治疗杂志,2015,29(4):396-398.
[4]郑盛,唐映梅,杨晋辉,等.MSCTP与内镜检查诊断肝硬化合并食管胃静脉曲张的比较[J].中华全科医学,2014,12(7):1127-1128.
[5]刘文娜,郝婷婷,王剑,等.64层螺旋CT门静脉造影对肝硬化患者肝功能分级和食管静脉曲张破裂出血的预测价值[J].实用肝脏病杂志,2014,17(3):283-286.
[6]孙潇,刘迎娣,孙国辉,等.合并胃肾或脾肾分流道的胃静脉曲张内镜下联合注射治疗[J].胃肠病学和肝病学杂志,2014,23(10):1141-1143.
[7]De Franchis R,Baveno VI Faculty.Expanding consensus in portal hy-pertension:veport of the BavenoⅥConsensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol,2015,63(3):743-752.
[8]Kondo T,Maruyama H,Sekimoto T,et al.Influence of paraumbilicalvein patency on the portal hemodynamics of patients with cirrhosis[J].J Clin Gastroenterol,2014,48(2):178-183.
[9]郑盛,唐映梅,杨晋辉,等.MSCTP与内镜检查诊断肝硬化合并食管胃静脉曲张的比较[J].中华全科医学,2014,12(7):1127-1128.
[10]罗贤明,刘晟.内镜下胃底静脉曲张粘合剂治疗前胃-肾静脉分流道介入栓塞的运用[J].中国内镜杂志,2012,18(11):1160-1163.
[11]李伟.多层螺旋CT门静脉成像评估肝硬化食管静脉曲张出血风险[J].胃肠病学和肝病学杂志,2013,22(12):1262-1266.
[12]刘文娜,郝婷婷,王剑,等.64层螺旋CT门静脉造影对肝硬化患者肝功能分级和食管静脉曲张破裂出血的预测价值[J].实用肝脏病杂志,2014,7(3):283-286.
[13]刘桂勤,沈加林.门静脉主干直径与肝硬化分级及肝性脑病的关系[J].中华实用诊断与治疗杂志,2014,28(5):488-489.
[14]何欣,黄仲奎,龙莉玲,等.比较多层螺旋CT门静脉成像与内镜检查诊断肝硬化合并食管胃静脉曲张的优劣[J].中国放射学杂志,2012,46(12):1092-1093.
[15]霍红,吴贵恺,刘国祥,等.无痛胃镜下序贯治疗食管胃底静脉曲张的疗效与安全性评价[J].中华消化病与影像杂志(电子版),2012,2(5):308-309.
[16]郝婷婷,马晓鹏,戴光荣,等.肝硬化门静脉高压患者食管静脉曲张CT表现预测首次上消化道出血的价值[J].胃肠病学和肝病学杂志,2017,26(1):29-31.
[17]向曼,张浩.多层螺旋CT诊断肝硬化食管胃静脉曲张的研究进展[J].现代医药卫生,2016,32(16):2531-2533.
[2]Kiyosue H,Ibukuro K,Maruno M,et al.Multidetector CTanatomy of drainage routes of gastric varices:a pictorialreview[J].Radiographics,2013,33(1):87-100.
[3]刘桂勤,华静,沈加林.CT门静脉血管成像预测肝硬化门静脉高压食管胃底静脉曲张破裂出血价值[J].中华实用诊断与治疗杂志,2015,29(4):396-398.
[4]郑盛,唐映梅,杨晋辉,等.MSCTP与内镜检查诊断肝硬化合并食管胃静脉曲张的比较[J].中华全科医学,2014,12(7):1127-1128.
[5]刘文娜,郝婷婷,王剑,等.64层螺旋CT门静脉造影对肝硬化患者肝功能分级和食管静脉曲张破裂出血的预测价值[J].实用肝脏病杂志,2014,17(3):283-286.
[6]孙潇,刘迎娣,孙国辉,等.合并胃肾或脾肾分流道的胃静脉曲张内镜下联合注射治疗[J].胃肠病学和肝病学杂志,2014,23(10):1141-1143.
[7]De Franchis R,Baveno VI Faculty.Expanding consensus in portal hy-pertension:veport of the BavenoⅥConsensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol,2015,63(3):743-752.
[8]Kondo T,Maruyama H,Sekimoto T,et al.Influence of paraumbilicalvein patency on the portal hemodynamics of patients with cirrhosis[J].J Clin Gastroenterol,2014,48(2):178-183.
[9]郑盛,唐映梅,杨晋辉,等.MSCTP与内镜检查诊断肝硬化合并食管胃静脉曲张的比较[J].中华全科医学,2014,12(7):1127-1128.
[10]罗贤明,刘晟.内镜下胃底静脉曲张粘合剂治疗前胃-肾静脉分流道介入栓塞的运用[J].中国内镜杂志,2012,18(11):1160-1163.
[11]李伟.多层螺旋CT门静脉成像评估肝硬化食管静脉曲张出血风险[J].胃肠病学和肝病学杂志,2013,22(12):1262-1266.
[12]刘文娜,郝婷婷,王剑,等.64层螺旋CT门静脉造影对肝硬化患者肝功能分级和食管静脉曲张破裂出血的预测价值[J].实用肝脏病杂志,2014,7(3):283-286.
[13]刘桂勤,沈加林.门静脉主干直径与肝硬化分级及肝性脑病的关系[J].中华实用诊断与治疗杂志,2014,28(5):488-489.
[14]何欣,黄仲奎,龙莉玲,等.比较多层螺旋CT门静脉成像与内镜检查诊断肝硬化合并食管胃静脉曲张的优劣[J].中国放射学杂志,2012,46(12):1092-1093.
[15]霍红,吴贵恺,刘国祥,等.无痛胃镜下序贯治疗食管胃底静脉曲张的疗效与安全性评价[J].中华消化病与影像杂志(电子版),2012,2(5):308-309.
[16]郝婷婷,马晓鹏,戴光荣,等.肝硬化门静脉高压患者食管静脉曲张CT表现预测首次上消化道出血的价值[J].胃肠病学和肝病学杂志,2017,26(1):29-31.
[17]向曼,张浩.多层螺旋CT诊断肝硬化食管胃静脉曲张的研究进展[J].现代医药卫生,2016,32(16):2531-2533.