高频超声检查与病理肝纤维化分期相关性的半定量研究

目的探讨高频超声综合观察肝包膜、肝实质回声、肝边缘、肝静脉改变与病理肝纤维化分期的相关性及对肝纤维化、肝硬化的诊断价值。方法无肝胆病对照组104例,疾病组577例均经超声引导下取肝活检组织,病理纤维化按2000年西安全国病毒性肝炎病理诊断标准进行分期,即分为S0~S45期,并进行分级评分。综合各项指标的评分值与病理纤维化分期进行对照分析。结果除S0与S1之间总积分差异无统计学意义外,余下各纤维化相邻分期之间差异均具有统计学意义;经ROC曲线分析,积分值为5~6诊断S1的敏感性67.3%,特异性84.9%,积分值为7~8诊断S2的敏感性78.2%,特异性83.5%,积分值为9~10诊断S3的敏感性81.9%,特异性84.3%,积分值大于10诊断S4的敏感性92.7%,特异性81.1%。结论随着肝纤维化分期的加重,超声总积分值逐渐增高,全面准确观察各项检测指标的细微变化,并进行综合评价,对无创性诊断肝纤维化分期具有重要的价值。

Correlation Between High-frequency Ultrasonography and Staging of Pathological Liver Fibrosis: A Semi-quantitative Study

Objective To investigate the correlation between the changes of Glisson's capsule,hepatic parenchymal echoes,margin and veins in patients with hepatitis on high-frequency ultrasonography and the staging of pathological liver fibrosis and to explore the sonographic value in diagnosing liver fibrosis and cirrhosis.Methods A total of 104 cases without liver diseases,blood and gallbladder diseases served as the control group,and 577 cases underwent biopsy under the ultrasound guidance as the patient group.The histological results of the biopsy samples were divided into 5 stages ranging from So(no liver fibrosis)to S4(liver cirrlosis).There were 73 cases in So,127 cases in S1,145 cases in S2,136 cases in S3 and 96 cases in S4 All the indices were scored and the scored values were comparatively analyzed with the staging of the pathological liver fibrosis.Results There was a significant difference in the total scores of the indices between the two groups.Except the total scores between S0 and S1,there were significant differences among the other adjacent stages of liver fibrosis.Analyzed with ROC,the sensitivity and specificity of score 5-6 were 67.3%and 84.9% respectively in the diagnosis of S1;score 7-8,78.2% and 83.5%respectively in S2;score 9-10,81.9%and 84.3%respectively in S3,score more than10,78.2% and 83.5%,respectively in S4. Conclusions Along with the increasing of the staging of liver fibrosis,the total scores of the indices were increased gradually.So,overall accurate evaluation of the slight changes of all the indices with high-frequency ultrasonography has an important value in non-invasive staging diagnosis of liver fibrosis.