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目的探讨肝硬化患者门静脉主干(main portal vein,MPV)和胃左静脉(left gastric vein,LGV)内径与肝功能Child-Pugh分级及食管胃底静脉曲张破裂出血(esophagogastric variceal bleeding,EVB)的关系。方法 90例肝硬化患者中54例有EVB史者为出血组,36例无出血史者为无出血组。患者均行门静脉系统CT血管成像,测量MPV及LGV内径,分析MPV及LGV内径与肝功能Child-pugh分级及EVB的相关性;采用ROC曲线判断MPV及LGV内径值对EVB的预测价值。结果 Child-pugh分级A、B、C级患者,MPV内径分别为(15.26±2.79)、(15.37±2.75)、(16.17±2.40)mm,其差异均无统计学意义(P>0.05);LGV内径分别为(5.25±1.41)、(6.49±1.97)、(6.58±2.44)mm,Childpugh分级B、C级患者LGV内径较A级患者增宽(P<0.05);EVB发生率分别为44.44%、67.65%、75.00%,差异均有统计学意义(P<0.05);出血组MPV内径[(15.75±2.23)mm]与无出血组[(15.14±3.25)mm]比较差异无统计学意义(P>0.05),LGV内径[(6.86±1.94)mm]较无出血组[(4.75±1.21)mm]增宽(P<0.05);(3)LGV内径值预测肝硬化患者发生EVB的最佳临界值为5.97mm,敏感度为81.5%,特异度为80.6%。结论 LGV内径可反映肝硬化患者肝脏储备功能,预测EVB发生的可能性。
Objective To investigate the relationship between the main portal vein (MPV) and left gastric vein (LGV) diameter, liver function Child-Pugh classification and esophagogastric variceal bleeding (EVB) in cirrhotic patients. . Methods Fifty-four patients with cirrhosis who had EVB history were bleeding group and 36 patients without history of bleeding were without bleeding group. Patients underwent CT angiography of the portal vein system. The MPV and LGV diameters were measured. The correlation between MPV, LGV inner diameter and Child-pugh classification of liver function and EVB was analyzed. The predictive value of MPV and LGV inner diameter to EVB was evaluated by ROC curve. Results There were no significant differences in MPV between Child-pugh class A, B and C patients (15.26 ± 2.79), (15.37 ± 2.75) and (16.17 ± 2.40) mm, respectively (5.25 ± 1.41), (6.49 ± 1.97) and (6.58 ± 2.44) mm respectively. The internal diameter of LGV in Childpugh class B and C patients was wider than that in class A patients (P <0.05). The incidences of EVB were 44.44% , 67.65%, 75.00%, respectively, the difference was statistically significant (P <0.05). There was no significant difference in the mean diameter of MPV between the bleeding group [(15.75 ± 2.23) mm and the no bleeding group (15.14 ± 3.25) mm (P <0.05). The mean diameter of LGV [(6.86 ± 1.94) mm] was significantly higher than that of no bleeding group [(4.75 ± 1.21) mm] The cut-off value was 5.97mm, the sensitivity was 81.5% and the specificity was 80.6%. Conclusion The inner diameter of LGV can reflect the liver reserve function in patients with cirrhosis and predict the possibility of EVB.