椎前髂静脉通道大小和下腰椎前凸角与性别、年龄的关系及其临床意义

目的 探讨椎前髂静脉通道矢状径(IVTD)和下腰椎前凸角(LLLA)与性别、年龄的关系及其临床意义。方法 收集2009年7月—2014年12月解放军第一七五医院(厦门大学附属东南医院)CT数据库中行腹盆部CT检查患者的资料进行回顾性分析。按年龄和性别分层简单随机抽样方法抽取320例为正常组,每年龄段(1～15,16～25,26～35,36～45,46～55,56～65,66～75及≥76岁)各40例,男女均等。收集同期55例(男18例,女37例)髂静脉压迫综合征(IVCS)患者的CT资料为IVCS组。分别在CT横断面和重建矢状面上测量椎前IVTD和LLLA。统计分析评估正常组LLLA和IVTD在男女性别间和各个年龄组间的差异采用方差分析和Bonferroni检验,Pearson相关分析LLLA和IVTD与年龄的相关性。在正常组中选择与IVCS组同年龄段者为对照组,采用独立样本t检验分别比较对照组与IVCS组中男性组、女性组间LLLA、IVTD的差异,分别建立预测男性和女性罹患IVCS风险的IVTD狭窄阈值。结果 正常组总体LLLA为128.1°±6.7°,椎前IVTD(4.9±1.2)mm,与年龄均呈负相关(r=-0.673、-0.662,P值均＜0.01);LLLA与IVTD呈正相关(r=0.812, P＜0.01)。其中,男性LLLA 为130.6°±6.1°、IVTD为(5.4±1.2)mm;女性LLLA为125.5°±6.0°、IVTD为(4.3±1.0)mm,男性LLLA和IVTD值均高于女性(t=7.426、9.103,P值均＜0.05)。IVCS组中,男性LLLA为123.3°±2.3°,IVTD为(2.5±0.3)mm ,与对照组男性的128.1°±2.7°、(5.0±0.8)mm比较,差异均有统计学意义(t=6.993、12.604, P值均<0.01);女性LLLA为122.1°±5.8°,IVTD为(2.3±0.4)mm,与对照组女性的125.1°±4.9°、(4.1±0.8)mm比较,差异均有统计学意义(t=2.898、12.906, P值均<0.01)。ROC预测IVCS的IVTD最适风险阈值,男性为2.98 mm,女性为2.96 mm,曲线下面积分别为0.99、0.98,其诊断敏感性分别为99%、93%,特异性均为100%。结论 LLLA和椎前IVTD在不同性别与年龄间存在差异, CT成像可以准确评估通道狭窄情况,预测罹患IVCS的风险。

Correlations of the iliac venous tunnel ahead the lower lumbar vertebrae and lower lumbar lordosis angle with sex,age and its clinical significance

Objective To measure the diameter of the iliac venous tunnel (IVTD) ahead the lower lumbar vertebrae and the lower lumbar lordosis angle (LLLA) using CT, and to analyze their clinical significance and the correlations between IVTD,LLLA and sex, and age, respectively.Methods Data of patients in the database of CT imaging of abdominal-pelvic part (lumbar spine included ) from July, 2009 to December, 2014 in southeast Hospital, Xiamen University were retrospectively analyzed, 320 health adults were selected by simple stratified sampling according to sex and age as the control group. Every age stage (1-15, 16-25, 26-35, 36-45, 46-55, 56-65, 66-75 years old and aged over 76) contained 40 objects with equal male and female. In the period, CT data of 55 patients with iliac vein compression syndrome (IVCS) were obtained as the IVCS group. The LLLA and the IVTD were measured respectively on CT transection and reconstructive sagittal plane. Differences of LLLA and IVTD between sex and in age of control group were assessed by variance analysis with Bonferroni test for correction of multiple comparison of mean. Pearson correlation analysis were used to evaluate the correlations of LLLA and IVTD with age respectively, Meanwhile, the discrepancies of LLLA and IVTD between control and IVTD groups were performed t test for males and females, respectively, and diagnostic thresholds of IVT stenosis for predicting IVCS were analyzed respectively for males and females by response of curve (ROC) of diagnostic tests.Results In the normal group, the LLLA was 128.1°±6.7° and IVTD was (4.9±1.2)mm, both were negatively correlated with age(r=-0.673, -0.662, all P values＜0.01). LLLA were positively correlated with positive correlation (r=0.812, P＜0.01). The LLLA of males was 130.6°±6.1° and females was 125.5°±6.0°. The IVTD of males was (5.4±1.2)mm and females was (4.3±1.0)mm. The LLLA and IVTD values of males were higher than females, there were statistical differences (t=7.426, 9.103, all P values＜0.05). In IVCS group, the LLLA of males was 123.3°±2.3° and IVTD was(2.5±0.3)mm, compared with the normal group128.1°±2.7°,(5.0±0.8)mm] there were statistical differences (t=6.993, 12.604, all P values <0.01). The LLLA of females was 122.1°±5.8° and IVTD was(2.3±0.4)mm, compared with the normal group 125.1°±4.9°, (4.1±0.8)mm] there were statistical differences(t=2.898,12.906, all P values<0.01). ROC of IVTD showed that 2.98 mm for males and 2.96 mm for females were their optimal cutoff value of IVTD predicting the risk of IVCS. The diagnostic sensitivity was 99%, 93%, and specificity in both groups was 100%, respectively.Conclusions The IVTD and LLLA are very different with sex and age, and CT imaging can exactly assess the condition of IVT and predict the risk of IVTS.