MSCT门静脉成像对门脉高压症中门静脉血栓形成与临床病情关系的研究

目的:采用64排螺旋CT门静脉成像探讨肝硬化(LC)门脉高压症(PH)门静脉血栓(PVT)形成对临床病程进展的影响。方法:对183例LC患者行CT检查,其中并发PVT者109例,无血栓者74例,应用MIP、MPR、CPR方法多角度多层面显示门静脉系统血管结构和侧支循环,测量血栓范围和狭窄程度。分别比较PVT组和对照组之间、不同Child-Pugh(CP)分级亚组间的肝功能、凝血功能、门脉系统血管宽度、侧支循环、脾脏大小的差异,分析PVT组各影像特征之间及其与肝功能的相关性。结果:PVT组与对照组间的血清总胆红素、门静脉和脾静脉宽度、脾面积、脾/胃-肾分流的差异均有统计学意义(t=-2.830、P=0.005;t=3.576、P<0.001;t=0.780、P=0.043;t=3.491、P=0.001;χ2=5.350、P=0.021),PVT组平均值均较高,且在CP的B和/或C级下差异有统计学意义(P<0.05),A级中差异无统计学意义(P>0.05);前腹壁静脉曲张在各分级中差异均有统计学意义(χ2=4.485,P=0.034)。PVT组肠系膜上静脉血栓与肠壁水肿有一定的相关性(r=0.227,P=0.018);脾静脉与胃左静脉宽度有一定的相关性(r=0.371,P<0.001)。结论:门静脉血栓形成与门脉高压症病情密切相关,可能为促进肝硬化临床病程发展的重要因素。

A study of the relationship between the portal vein thrombosis and clinical progression in portal hypertension on multi-slice CT portal venography

Objective： To investigate the effect of the portal vein thrombosis （PVT） on disease progression of liver cirrhosis （LC） portal hypertension （PH） using CT portal venography （CTPV）. Methods ：183 patients with LC, divided into PVT group （n= 109） and control group （n= 74）, were performed by multi-slice CT （MSCT）. MIP, MPR and CPR were used to display the portal venous system and collateral circulations,and to measure the thrombosis as well as stenosis. The liver function, coagulation function, the imaging features of portal veins and PVT were compared between these two groups, then in different Child-Pugh （CP） classifications. Results： There were significant differences between the two groups in total serum bilirubin, the width of main portal vein （MPV） and spleen vein （SPV）, sectional area of spleen, splenic or gastric-re nal shunt （t=-- 2. 830,P=0. 005 ;t= 3. 576,P〈0.001;t=0. 780,P=0. 043;t= 3. 491,P=0. 001 x2=5.350,P=0.021, espectively）, and all the indexes mean values of PVT group were higher than the control group. The difference between CP B and C grade was also significant （P〈0.05）. The anterior abdominal wall varices showed significant difference in all CP subgroups （2 =4. 485 ,P=0. 034）. There was consistence between superior mesenteric vein thrombosis and edema of intes- tine wall （r=0. 227,P=0. 018） ,as well as the width of SPV and left gastric vein （r=0. 371,P〈0. 001）. Conclusion：PVT was closely related to clinical cause of portal hypertension,while it may become an important factor in the clinical progres- sion of LC portal hypertension.