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目的探讨经多层螺旋CT门静脉成像(MSCTP)与消化内镜检查评估肝硬化并食管胃静脉曲张有无、分型、分级的一致性。方法前瞻性分析临床诊断为肝硬化的患者184例,4周内先后行消化道内镜及腹部MSCTP检查,观察食管、胃有无静脉曲张并进行分型、分级。以内镜结果作为金标准,对MSCTP与内镜判断食管胃静脉曲张的有无、分型、分级行Kappa一致性检验,并计算MSCTP诊断食管胃静脉曲张(EGV)的敏感度、特异度、一致率、Youden指数。结果内镜诊断食管胃静脉曲张阴性54例,阳性130例;食管胃静脉曲张分型为:GOV1型90例、GOV2型38例、IGV1型2例。MSCTP诊断食管胃静脉曲张阴性50例,阳性134例;食管胃静脉曲张分型为:GOV1型92例、GOV2型36例、IGV1型6例。MSCTP发现内镜未诊断的4例IGV1型静脉曲张,其MSCTP表现为胃黏膜下孤立存在的胃静脉曲张。MSCTP与内镜EGV诊断结果一致性较高,Kappa=0.732,P<0.01;MSCTP诊断EGV的敏感度93.8%,特异度77.8%,一致率89.1%,Youden指数71.6%。MSCTP与内镜EGV的分型及分级结果一致性均较高,Kappa值分别为0.743和0.763,P值均<0.01。结论 MSCTP诊断肝硬化合并食管胃静脉曲张的有无、分型、分级,与消化内镜有较高的一致性。对于诊断胃静脉曲张,MSCTP优于内镜。
Objective To evaluate the consistency of classification, classification and classification of cirrhosis and esophagogastric varices by multislice spiral CT portography (MSCTP) and digestive endoscopy. Methods A total of 184 patients with cirrhosis were prospectively analyzed. The endoscopic and endoscopic examination of the digestive tract was performed in 4 weeks. The esophageal and gastric varices were observed and classified. Endoscopic results as the gold standard, MSCTP and endoscopy to determine esophagogastric varicose veins, classification, grading Kappa consistency test, and calculate the sensitivity of MSCTP diagnosis of esophageal varices (EGV) sensitivity, specificity, consistent Rate, Youden index. Results The endoscopic diagnosis of gastroesophageal varices negative in 54 cases, positive 130 cases; esophagogastric varices type: GOV1 type 90 cases, GOV2 type 38 cases, IGV1 type in 2 cases. MSCTP diagnosis of gastroesophageal varices negative in 50 cases, 134 cases of positive; esophagogastric varices type: GOV1 type 92 cases, GOV2 type 36 cases, IGV1 type 6 cases. 4 cases of IGV1 varicose veins without endoscopy were found by MSCTP, and gastric varices existed in the gastric mucosa isolated by MSCTP. The consistency between MSCTP and endoscopic EGV was high, Kappa = 0.732, P <0.01. The sensitivity and specificity of MSCTP in diagnosing EGV were 93.8%, 77.8%, 89.1% and 71.6%, respectively. The consistency and classification results of MSCTP and endoscopic EGV were higher, Kappa values were 0.743 and 0.763, P values were <0.01. Conclusion MSCTP diagnosis of cirrhosis with esophagogastric varices with or without, classification, classification, and digestive endoscopy have a higher consistency. For the diagnosis of gastric varices, MSCTP is superior to endoscopy.