多层螺旋CT肝脏灌注预测肝硬化门静脉高压并上消化道出血风险性价值

目的 探究多层螺旋CT肝脏灌注预测肝硬化门静脉高压并上消化道出血风险性价值。方法 对笔者医院肝硬化门静脉高压者进行研究，其中未出血者31例，出血者21例，另选取30例体检正常者作为对照组，所有研究对象均进行CT灌注成像。对比3组肝动脉灌注量（HAP）、门静脉灌注量（PVP）、肝脏总灌注量（THP）、肝动脉灌注指数（HPI）以及静脉内径参数：门静脉直径（PVD）、脾静脉直径（SVD）、肠系膜上静脉直径（SMVD）、胃冠状静脉直径（GCVD）水平，统计脾门-胃底静脉血管截面数量、血管总面积，创建受试者工作特征曲线（ROC），对比不同指标曲线下面积（AUC）。结果 与对照组比较，肝硬化门静脉高压患者PVP、THP降低，HPI升高，出血组变化程度高于未升高组；与对照组比较，肝硬化门静脉高压患者PVD、SVD、SMVD、GCVD水平以及血管截面数量、血管总面积均升高，且出血组静脉内径变化程度高于未出血组，差异均有统计学意义（P<0.05）。Logistic多因素回归分析显示，GCVD、血管截面数量、血管面积与上消化道出血发生具有显著相关性（OR=1.398，OR=1.427，OR=1.394），差异有统计学意义（P<0.05）。ROC曲线显示血管面积AUC值（0.826）高于GCVD、血管截面数量（0.702、0.768），预测价值最高。结论 GCVD、血管截面数量、血管面积均能够预测肝硬化门静脉高压并上消化道出血，其中静脉血管面积预测价值最高。

Risk Value of Multi-slice Spiral CT Liver Perfusion in Forecast of Cirrhosis Portal Hypertension Complicated with Upper Gastrointestinal Hemorrhage

Objective To explore the risk value of multi-slice spiral CT liver perfusion in forecast of cirrhosis portal hypertension complicated with upper gastrointestinal hemorrhage. Methods Cirrhotic portal hypertension patients in our hospital were studied, including non-hemorrhage in 31 cases and hemorrhage in 21 cases. 30 cases of normal physical examination persons were as the control group, and all the study objects were undergoing CT perfusion imaging. Hepatic artery perfusion (HAP), portal venous perfusion (PVP), total liver perfusion (THP), hepatic artery perfusion index (HPI) and vein diameter parameters of portal vein diameter (PVD), splenic vein diameter (SVD), superior mesenteric vein diameter (SMVD), gastric coronary vein diameter (GCVD) levels were contrasted in the three groups. The number of cross section of portal gastric fundus vein, total area of the blood vessel, and receivers'' operating characteristic curve (ROC) created, and the area under different index curves (AUC) was contrasted. Results Compared with those in the control group, PVP and THP decreased of patients with cirrhosis and portal hypertension, and HPI increased, and the degree of change in hemorrhage group was higher than that in non hemorrhage group. Compared with those in the control group, PVD, SVD, SMVD, GCVD levels of cirrhotic patients with portal hypertension increased, and the degree of vein diameter changes in hemorrhage group was higher than that in non hemorrhage group, with statistically significant difference (P<0.05). Logistic multivariate regression analysis showed that there was a significant correlation between the occurrence of upper gastrointestinal hemorrhage and GCVD, the number of vascular section and the area of blood vessel (OR=1.398, OR=1.427, OR=1.394), with statistically significant difference (P<0.05). ROC curve showed that AUC value of the vascular area (0.826) was higher than that of GCVD and the number of vascular sections (0.702, 0.768), and predictive value was the highest. Conclusion GCVD, the number of vascular section and the area of vessel can be used to predict portal hypertension and upper gastrointestinal hemorrhage, and the value of venous vessel area is the highest.