门静脉CT血管成像在肝硬化自发性门体分流评估中的应用

Application of CT portal venography in the evaluation of spontaneous portosystemic shunts in patients with liver cirrhosis

    摘要
  • 摘要:
    目的 探讨门静脉CT血管成像在肝硬化自发性门体分流（SPSS）评估中的应用及SPSS与肝硬化并发症的关系。
    方法 回顾性分析2020年1月至2022年6月就诊于南通大学附属南通第三医院的126例肝硬化患者的临床资料及CT影像资料，其中男性71 例、女性55例，年龄（55.7±10.3）岁。所有患者根据门静脉CT血管成像判断是否存在SPSS，并按照分流道内径大小将SPSS患者分为大自发性门体分流组（L-SPSS，n=30）和小自发性门体分流组（S-SPSS，n=46），无SPSS患者（W-SPSS组，n=50）作为对照组。分析SPSS的发生、分流道内径与肝功能、肝性脑病、腹水、门静脉血栓、消化道出血的相关性。符合正态分布的计量资料的多组间比较采用单因素方差分析，2组间比较采用t检验；计数资料的组间比较采用χ2检验。采用多因素Logistic 回归分析确定肝硬化患者 SPSS的独立危险因素。Pearson相关分析用于分流道内径与门静脉主干内径的相关性分析。
    结果 L-SPSS组和S-SPSS组患者的Child评分及Child-Pugh B、C分级所占比例均高于W-SPSS组（10.03±2.91）分对（7.09±2.54）分对（5.64±2.95）分，26.7%对43.5%对18.0%，56.7%对17.4%对10.0%，且差异均有统计学意义（F=23.210、χ2=36.974，均P<0.001），而白蛋白水平、肝体积及门静脉主干内径均小于W-SPSS组（34.97±5.22）g/L对（36.30±3.30）g/L对（37.59±4.05）g/L，（1183.91±367.31） mm3对（1357.24±582.76） mm3对（1475.68±432.46） mm3，（13.23±2.53） mm对（14.17±1.87） mm对（14.64±2.26） mm，且差异均有统计学意义（F=3.775、3.467、3.869，均P<0.05）。L-SPSS组患者肝性脑病、腹水、门静脉血栓的发生率均高于S-SPSS组和W-SPSS组（63.3%对43.5%对16.0%，80.0%对60.9%对36.0%，66.7%对37.0%对24.0%），且差异均有统计学意义（χ2=19.144、15.530、14.476，均P<0.05）。在SPSS患者中，分流道内径与门静脉主干内径呈负相关（r=−0.8546，P<0.05）。多因素Logistic 回归分析结果表明，Child-Pugh分级（OR=1.392，95%CI：0.595~3.158，P=0.043）、肝性脑病（OR=5.934，95%CI：1.875~15.436，P=0.003）、门静脉血栓（OR=5.332，95%CI：1.792~14.382，P=0.002）、SPSS类型（OR=2.531，95%CI：1.207~5.322，P=0.014）、SPSS分流道内径（OR=1.021，95%CI：1.010~1.037，P<0.001）是SPSS的独立危险因素。
    结论 SPSS在肝硬化患者中的发生率较高，门静脉CT血管成像可有效评估SPSS，为肝硬化患者诊疗方案的选择及预后评估提供参考。

     

    Abstract:
    Objective  To explore the application of CT portal venography in the evaluation of spontaneous portosystemic shunts (SPSS) in patients with liver cirrhosis and determine the relationship between SPSS and complications of liver cirrhosis.
    Methods  The imaging and clinical data of 126 patients with liver cirrhosis in Affiliated Nantong Third Hospital of Nantong University from January 2020 to June 2022 were analyzed retrospectively. The patients included 71 males and 55 females, aged (55.7±10.3) years. All patients were evaluated for the presence of SPSS based on CT portal venography and divided into two groups according to the diameter of the shunt: large spontaneous portosystemic shunts (L-SPSS, n=30) and small spontaneous portosystemic shunts (S-SPSS, n=46) groups. Patients without spontaneous portosystemic shunts (W-SPSS, n=50) were used as the control group. The relationship among the presence of SPSS, shunt diameter and liver function, hepatic encephalopathy, ascites, portal vein thrombosis, and gastrointestinal bleeding were analyzed. One-way ANOVA was used to compare measured data with normal distribution among multiple groups. T-test was used to compare the two groups. Chi-square test was used to compare counting data between groups. Independent risk factors associated with SPSS in patients with liver cirrhosis were evaluated by multivariable Logistic regression analysis. Pearson correlation test was performed between shunt diameter and portal vein diameter.
    Results  Child scores and percentage of patients with Child-Pugh grade B or C in the L-SPSS group and S-SPSS group were higher than those in the W-SPSS group ((10.03±2.91) scores vs. (7.09±2.54) scores vs. (5.64±2.95) scores, 26.7% vs. 43.5% vs. 18.0%, 56.7% vs. 17.4% vs. 10.0%), and the differences were statistically significant (F=23.210, χ2=36.974, all P<0.001). Albumin level, liver volume, and portal vein diameter were smaller than those in the W-SPSS group ((34.97±5.22) g/L vs. (36.30±3.30) g/L vs. (37.59±4.05) g/L, (1183.91±367.31) mm3 vs. (1357.24±582.76) mm3 vs. (1475.68±432.46) mm3, (13.23±2.53) mm vs. (14.17±1.87) mm vs. (14.64±2.26) mm), and the differences were statistically significant (F=3.775, 3.467, 3.869, all P<0.05). The incidence rates of hepatic encephalopathy, ascites, and portal vein thrombosis in the L-SPSS group were higher than those in the S-SPSS group and W-SPSS group (63.3% vs. 43.5% vs. 16.0%, 80.0% vs. 60.9% vs. 36.0%, 66.7% vs. 37.0% vs. 24.0%), and the differences were statistically significant (χ2=19.144, 15.530, 14.476, all P<0.05). An inverse correlation was found between shunt diameter and portal vein diameter (r=−0.854 6, P<0.05) in SPSS patients. The results of multiple Logistic regression analysis showed that the independent risk factors for SPSS included Child-Pugh grade (OR=1.392, 95%CI: 0.595–3.158, P=0.043), hepatic encephalopathy (OR=5.934, 95%CI: 1.875–15.436, P=0.003), portal vein thrombosis (OR=5.332, 95%CI: 1.792–14.382, P=0.002), SPSS type (OR=2.531, 95%CI: 1.207–5.322, P=0.014), and shunt diameter (OR=1.021, 95%CI: 1.010–1.037, P<0.001).
    Conclusions  SPSS has a high incidence in patients with liver cirrhosis. CT portal venography can effectively evaluate SPSS and provide reference for the selection of treatment plan and the prognosis evaluation of patients with liver cirrhosis.

     

    • HTML全文
    • 参考文献(17)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回