Ding Min, Yin Yue, Wang Xueying, Zhu Menghua, Xu Shixue, Wang Le, Yi Fangfang, Abby Philips Cyriac, Gomes Romeiro Fernando, Qi Xingshun
Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China.
Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China.
J Transl Int Med. 2023 Mar 19;12(3):308-316. doi: 10.2478/jtim-2022-0076. eCollection 2024 Jun.
Morphologic changes in the gallbladder and gallstones are common in cirrhotic patients, but their associations with outcomes of cirrhotic patients are unclear.
We retrospectively enrolled 206 cirrhotic patients and measured their gallbladder length and width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width in axial contrast-enhanced computed tomography (CT) images. X-tile software was utilized to calculate the optimal cutoff values of these parameters for evaluating survival and hepatic decompensation events in the cirrhosis group. Their associations with survival were explored by Cox regression analyses and Kaplan-Meier curve analyses. Their associations with hepatic decompensation events were evaluated by competing risk analyses and Nelson-Aalen cumulative risk curve analyses where death was a competing event.
Cirrhotic patients with gallbladder length < 72 mm had a significantly higher cumulative survival rate than those with a length of ≥ 72 mm ( = 0.049 by log-rank test), but gallbladder width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width were not significantly associated with survival ( = 0.10, = 0.14, = 0.97, = 0.73, and = 0.73 by log-rank tests, respectively). Cirrhotic patients with gallbladder wall thickness < 3.4 mm had a significantly lower cumulative rate of hepatic decompensation events than those with a wall thickness of ≥ 3.4 mm ( = 0.02 by Gray's test), but gallbladder length and width, presence of gallstones, and gallstones' length and width were not significantly associated with hepatic decompensation events ( = 0.15, = 0.15, = 0.54, = 0.76, and = 0.54 by Gray's tests, respectively).
Changes in gallbladder length and gallbladder wall thickness, rather than gallstone parameters, may be in parallel with the long-term outcomes of cirrhotic patients.
胆囊形态改变和胆结石在肝硬化患者中很常见，但它们与肝硬化患者预后的关联尚不清楚。
我们回顾性纳入了206例肝硬化患者，并在轴向对比增强计算机断层扫描（CT）图像中测量了他们的胆囊长度和宽度、胆囊壁厚度、胆结石的存在情况以及胆结石的长度和宽度。利用X-tile软件计算这些参数的最佳截断值，以评估肝硬化组的生存情况和肝失代偿事件。通过Cox回归分析和Kaplan-Meier曲线分析探讨它们与生存的关联。通过竞争风险分析和Nelson-Aalen累积风险曲线分析评估它们与肝失代偿事件的关联，其中死亡为竞争事件。
胆囊长度<72 mm的肝硬化患者的累积生存率显著高于胆囊长度≥72 mm的患者（对数秩检验P = 0.049），但胆囊宽度、胆囊壁厚度、胆结石的存在情况以及胆结石的长度和宽度与生存无显著关联（对数秩检验P分别为0.10、0.14、0.97、0.73和0.73）。胆囊壁厚度<3.4 mm的肝硬化患者的肝失代偿事件累积发生率显著低于胆囊壁厚度≥3.4 mm的患者（Gray检验P = 0.02），但胆囊长度和宽度、胆结石的存在情况以及胆结石的长度和宽度与肝失代偿事件无显著关联（Gray检验P分别为0.15、0.15、0.54、0.76和0.54）。
胆囊长度和胆囊壁厚度的变化，而非胆结石参数，可能与肝硬化患者的长期预后相关。
