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肝硬化和门静脉高压食管静脉曲张患者首次上消化道出血的计算机断层扫描风险评估

Risk assessment of first upper gastrointestinal bleeding using computerized tomoscanning in esophageal varices patients with cirrhosis and portal hypertension.

作者信息

Xie Wei, Chen Fa-Xiang, Zhu Li-Yao, Wen Cheng-Cai, Zhang Xin

机构信息

Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.

Department of Hepatology, The Fourth People's Hospital of Huai'an, Jiangsu.

出版信息

Medicine (Baltimore). 2020 Jan;99(5):e18923. doi: 10.1097/MD.0000000000018923.

DOI:10.1097/MD.0000000000018923
PMID:32000404
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7004787/
Abstract

To evaluate the risk of first upper gastrointestinal bleeding by computerized tomoscanning (CT) for esophageal varices patients with cirrhotic portal hypertension.One hundred thirty two esophageal varices patients with cirrhotic portal hypertension who are also complicated with gastrointestinal bleeding were recruited as bleeding group, while another 132 patients without bleeding as non-bleeding group. The diameter of esophageal varices, number of vascular sections, and total area of blood vessels were measured by CT scanning. The sensitivity and specificity of these indicators were calculated, and Youden index was adjusted with the critical point.The diameter of esophageal varices was 7.83 ± 2.76 mm in bleeding group, and 6.57 ± 3.42 mm in non-bleeding group. The Youden index was 0.32 with the critical point 5.55 mm. The area under the receiver operating characteristics (AUROC) was 0.72. The number of venous vessels was 4.5 ± 2 in bleeding group, whereas being 4 ± 2 in non-bleeding group. The Youden index was 0.35 with a critical point 4, and the area under the curve (AUC) was 0.68. The blood vessel area was 1.73 ± 1.15 cm in bleeding group, and 1.12 ± 0.89 cm in non-bleeding group. The Youden index was 0.48 with the critical point being 1.03 cm, and corresponding AUC was 0.82.Among all 3 indicators of the total area, diameter, and number of sections of the esophageal varices, the total area of esophageal varices showed more accuracy as a potential and novel indicator for bleeding prediction.

摘要

评估计算机断层扫描(CT)对肝硬化门静脉高压食管静脉曲张患者首次上消化道出血的风险。选取132例肝硬化门静脉高压合并食管静脉曲张且并发消化道出血的患者作为出血组,另132例未出血患者作为非出血组。通过CT扫描测量食管静脉曲张的直径、血管节段数和血管总面积。计算这些指标的敏感性和特异性,并根据临界点调整约登指数。出血组食管静脉曲张直径为7.83±2.76mm,非出血组为6.57±3.42mm。临界点为5.55mm时,约登指数为0.32。受试者工作特征曲线下面积(AUROC)为0.72。出血组静脉血管数为4.5±2,非出血组为4±2。临界点为4时,约登指数为0.35,曲线下面积(AUC)为0.68。出血组血管面积为1.73±1.15cm,非出血组为1.12±0.89cm。临界点为1.03cm时,约登指数为0.48,相应的AUC为0.82。在食管静脉曲张的总面积、直径和节段数这3个指标中,食管静脉曲张总面积作为出血预测的潜在新指标显示出更高的准确性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d3dc/7004787/991254210230/medi-99-e18923-g010.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d3dc/7004787/991254210230/medi-99-e18923-g010.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d3dc/7004787/c9e82ab2f367/medi-99-e18923-g008.jpg
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