摘要
目的探索超声二维图像和多普勒血流显像对慢性病毒性肝炎患者中纤维化程度和早期肝硬化的诊断价值.方法 324例慢性病毒性肝炎患者根据肝穿刺活检组织学结果分为无肝纤维化(S0)到肝硬化(S4)五期.活检组织按炎症分级为G1～G4四级.比较各组间超声指标的差异.结果在超声定性指标中,肝表面回声,肝实质光点形态和分布异常等指标都与肝纤维化分期和炎症分级有相关性.但这些定性指标对具体患者的诊断判断变异很大.在不同纤维化程度分组间,脾长径,脾门静脉内径在各组间差异有统计学意义.根据脾长径界限值12.1 cm,诊断早期肝硬化的敏感度为60.0%,特异性为75.3%;脾静脉内径以8 mm作为界限值,诊断早期肝硬化的敏感度为60.0%,特异性为78.1%;门静脉主干内径12 mm,诊断早期肝硬化的敏感度76.7%,特异性44.6%.门静脉最大流速界限值为30.5 cm/s时,诊断早期肝硬化的敏感度为78.6%,特异性为66.9%.结论超声检查是诊断早期肝硬化的有效工具,是临床实用的方法,并适用于随访复查.
Objective It is important to use noninvasive methods to differentiate liver fibrosis and liver cirrhosis. A prospective study was conducted to evaluate the validity of ultrasonography (US) in evaluating the severity of liver fibrosis in patients with chronic viral hepatitis in reference to the pathologic diagnosis of their liver biopsy specimens. Methods The liver fibrosis status of 324 chronic viral hepatitis patients was evaluated by both needle biopsy and US. Histologically their liver fibrosis was graded as S0-S4, and the inflammatory reaction in the liver was graded as G1-G4. The US examination included qualitative description of the liver surface and liver parenchyma, and the quantitative parameters were vascular diameters, blood flow volume and spleen size. Results US qualitative description of the liver surface and liver parenchyma was correlated to the severity of fibrosis and the degree of the inflammation seen in the liver biopsies. An analysis of US quantitative parameters showed that a cut-off value of 12.1 cm for the length of spleen had a sensitivity of 60.0%, and specificity of 75.3% in detecting early liver fibrosis. For other quantitative parameters, the cut-off values were 8mm for the diameter of the splenic vein, 30.5 cm/sec for maximal blood flow velocity in the portal vein and 12 mm in diameter of the main portal vein. The diagnostic sensitivities for these parameters were 60.0%, 78.6% and 76.7%; the diagnostic specificities were 78.1%, 66.9% and 44.6% respectively. Conclusions Early cirrhosis can be detected by US, and the sonographic results were well paralleled with their pathologic diagnoses made by liver biopsies. Individual US parameter has limited sensitivity and specificity in diagnosing early cirrhosis. In clinical practice a combination of 2-3 parameters could be used to detect or exclude severe liver fibrosis.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2005年第2期117-120,共4页
Chinese Journal of Hepatology
基金
上海市医学发展基金重点研究项目(99ZDI001)
