【摘要】 目的:探讨CT门静脉成像(CTPV)的血管参数对胃肾分流的预测价值。方法:回顾性分析2019年3月—2024年6月北海市人民医院收治的285例肝硬化门脉高压患者的CT影像资料,经数字减影血管造影(DSA)证实无脾/胃-左肾分流患者211例纳入无脾/胃-左肾分流组,胃肾分流患者74例纳入胃肾分流组,比较两组一般资料、并发症发生情况及血管参数,采用Spearman相关性分析胃肾分流程度与血管参数的相关性,采用二元Logistic回归筛选胃肾分流存在的独立影响因素,应用受试者工作特征(ROC)曲线评估CTPV血管参数预测胃肾分流的价值。结果:两组食管曲张静脉、门静脉、脾静脉、胃左静脉、胃后静脉、胃短静脉、左膈下静脉直径比较,差异有统计学意义(P<0.05);Spearman相关性分析结果显示,胃肾分流程度与门静脉直径呈负相关,与胃左静脉、胃后静脉、左膈下静脉直径呈正相关(P<0.05);二元Logistic回归分析显示,胃后静脉、左膈下静脉是胃肾分流发生的独立影响因素(P <0.05);ROC曲线结果显示,胃后静脉、左膈下静脉联合预测胃肾分流的曲线下面积(AUC)高于两者单独检测(P <0.05),CTPV血管直径预测存在胃肾分流组准确率为92.98%,预测胃肾分流存在效能较高(Kappa=0.804)。结论:CTPV测量血管直径以胃后静脉≥2.40 mm、左膈下静脉≥4.55 mm为截断值,对胃肾分流预测效能较高,胃后静脉、左膈下静脉联合预测胃肾分流的效能良好。更多还原

【Abstract】 Objective To investigate the predictive value of vascular parameters from CT portal venography(CTPV) for gastrorenal shunt.Methods A retrospective analysis was conducted on CT imaging data of 285 patients with cirrhotic portal hypertension,who had admitted to Beihai Municipal People s Hospital between March 2019 and June 2024.Among these,211 patients without splenic/gastric-left renal shunt confirmed via digital subtraction angiography(DSA) were included in no splenic/gastric-left renal shunt group,while 74 patients with gastric-renal shunt were included in gastrorenal shunt group.General data,complications,and vascular parameters were compared between the two groups.Spearman correlation was used to analyze the correlation between the degree of gastrorenal shunt and vascular parameters.Binary logistic regression was used to screen independent influencing factors of gastrorenal shunt Receiver operating characteristic(ROC) curve was used to evaluate the predictive value of CTPV vascular parameters for gastrorenal shunt.Results There were statistically significant differences in diameters of esophageal varices,portal vein,splenic vein,left gastric vein,posterior gastric vein,short gastric vein,and left subdiaphragmatic vein between the two groups(P <0.05).Spearman correlation analysis revealed that the degree of gastrorenal shunt was negatively correlated with the diameter of portal vein,and positively correlated with the diameters of the left gastric vein,posterior gastric vein,and left subdiaphragmatic vein(P <0.05).Binary logistic regression analysis showed that the posterior gastric vein and left subdiaphragmatic vein were independent influencing factors of gastrorenal shunt(P<0.05).ROC curve results indicated that the area under the curve(AUC) of combination detection of the posterior gastric vein and left subdiaphragmatic vein in predicting gastrorenal shunt was higher than that of single detection(P <0.05).The accuracy of CTPV vascular diameter in predicting the existence of gastrorenal shunt group was 92.98%.The predictive efficacy for gastrorenal shunt was high(Kappa=0.804).Conclusions Vascular diameters by CTPV measurement are equal to or more than 2.40 mm in the posterior gastric vein and equal to or more than 4.55 mm in the left subdiaphragmatic vein,which are used as cut-off values,and it demonstrates high predictive efficacy for gastrorenal shunt.The combination of posterior gastric vein and left subdiaphragmatic vein have better predictive efficacy for gastrorenal shunt.更多还原