Relationship Between CT Features Of Spontaneous Portosystemic Shunt And Complications Of Liver Cirrhosis

Objective:To investigate the relationship between the existence of spontaneous portosystemic shunt and the CT imaging features and complications in patients with liver cirrhosis.Materials and methods:This study collected 1130 cirrhotic patients over 18 years old who were treated in the first Hospital of Jilin University from January 2019 to January 2021.According to the inclusion criteria and exclusion criteria,295 patients with liver cirrhosis with sufficient clinical data were included in the study.Including 183 patients with spontaneous portosystemic shunts（SPSS）as the case group and 112 patients without spontaneous portosystemic shunts（SPSS）served as the control group.The general information of patients,laboratory indexes,liver function,complications of liver cirrhosis（ascites,hepatic encephalopathy,gastrointestinal hemorrhage,spontaneous bacterial peritonitis,hepatorenal syndrome,etc.）and CT imaging features（SPSS types,diameter,number,longitudinal meridian of spleen,portal vein diameter,splenic vein diameter,portal vein thrombosis,etc.）were observed and recorded.SPSS 25.0 software was used for statistical analysis.P<0.05 means there is statistical significance.The trend description in the measurement data set accords with the normal distribution and the variance is uniform,which is expressed by the average±standard deviation（±S）,and the quantitative data with skewness distribution is expressed by the median（quartile interval）M(P₂₅,P₇₅).T-test was used to analyze the measurement data if they were normal distribution.If they were not normal distribution,Mann-Whitney U test is used to compare the two groups of data.Chi-square test or Fisher’s exact test was used for comparison about qualitative data.The logistic multifactor regression was used to analyze the independent factors of spontaneous portosystemic shunts in patients with liver cirrhosis.Results:295 patients with liver cirrhosis were included in this study,including 183 patients with SPSS and 112 patients without SPSS.The incidence of SPSS was 62%,54.64%of patients found to have more than one type of SPSS.Two groups of patients with serum ALT level and WBC level P values were 0.006,0.046,with statistical significance（P<0.05）.The longitudinal meridian of spleen in patients with SPSS was greater than that in patients without SPSS（P=0.025）,and the incidence of portal vein thrombosis（21.3%）was higher than that in patients without SPSS（18.6%）（P=0.006）.The incidence of gastroesophageal varices in patients with SPSS（91.3%）was higher than that in patients without SPSS（77.7%）（P=0.001）.Multivariate analysis of binary logistic regression showed that male,longitudinal meridian of spleen,portal vein thrombosis,ALT,hepatic encephalopathy,gastrointestinal hemorrhage,spontaneous bacterial peritonitis and gastroesophageal varices were independently correlated with the existence of SPSS.In this study,there was significant difference in the occurrence of gastrorenal shunt between compensated patients with liver cirrhosis and decompensated patients（P=0.026）.Conclusion:1.In this study,the incidence of spontaneous portosystemic shunts（SPSS）was 62%.The most common type of SPSS was paraumbilical shunt（57.38%）,followed by Inferor epigastric vein（33.88%）,followed by gastrorenal shunt（32.24%）.More than one type of SPSS was found in54.64%of patients.2.To some extent,SPSS can reduce the pressure of portal vein,affect the diameter of main portal vein and splenic vein,and lead to the formation of portal vein thrombosis.3.The course of liver cirrhosis is dynamic.In the early stage,SPSS can be used as a compensatory mechanism to partially reduce portal hypertension and its complications.With the progress of the course,insufficient hepatocyte perfusion is more likely to lead to the occurrence of liver cirrhosis complications.