CT对肝硬化患者首次食管静脉曲张出血的预测价值：脐旁静脉通畅情况的价值

Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: Value of para-umbilical vein patency.

作者信息

Calame Paul, Ronot Maxime, Bouveresse Sébastien, Cervoni Jean-Paul, Vilgrain Valérie, Delabrousse Éric

机构信息

Department of Radiology, University Hospitals of Besançon, France.

Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.

出版信息

Eur J Radiol. 2017 Feb;87:45-52. doi: 10.1016/j.ejrad.2016.12.006. Epub 2016 Dec 9.

DOI:10.1016/j.ejrad.2016.12.006

PMID:28065374

Abstract

PURPOSE

To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH.

MATERIALS AND METHODS

From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV>5mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients.

RESULTS

172 patients (113 men, mean 60±12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p=0.005). At multivariate analysis, factors associated with a first EVH were spleen size>135mm (Odd Ratio [OR]=1.32 [95% confident interval [CI] 1.16-1.51], p<0.001), ascites (OR=4.07 [95%CI-1.84-9.01], p=0.001) and small/absent PUV (OR=3.06 [95%CI-1.86-5.05], p<0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0-1, 2-3, and 4-5, respectively).

CONCLUSIONS

A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.

摘要

目的

评估肝硬化患者计算机断层扫描（CT）上脐旁静脉（PUV）的存在/大小是否与首次食管静脉曲张出血（EVH）相关，以及影像学特征是否有助于识别EVH风险增加的患者。

材料与方法

纳入2010年1月至2012年6月期间在6个月内接受CT和上消化道内镜检查的肝硬化患者。记录PUV的存在/大小。PUV>5mm被认为是粗大的（LPUV）。寻找与首次EVH的相关性，并在55例患者的前瞻性队列中进行验证。

结果

纳入172例患者（113例男性，平均年龄60±12岁）。43例患者（25%）发生首次EVH。粗大PUV在无EVH组中更常见（27%对7%，p=0.005）。多因素分析显示，与首次EVH相关的因素包括脾脏大小>135mm（比值比[OR]=1.32[95%置信区间[CI]1.16-1.51]，p<0.001）、腹水（OR=4.07[95%CI-1.84-9.01]，p=0.001）和细小/无PUV（OR=3.06[95%CI-1.86-5.05]，p<0.001）。结合这些因素的影像学评分在研究队列和验证队列中与首次EVH显著相关（评分0-1、2-3和4-5时，EVH发生率分别为0%、19%和33%）。