超声造影与剪切波弹性成像评估慢性乙型肝炎肝纤维化的对比研究

目的探讨超声造影与剪切波弹性成像(SWE)在慢性乙型肝炎(CHB)肝纤维化评估中的应用价值。方法选取我院行肝穿刺活检的CHB患者120例,根据活检结果分为无纤维化组(S0期)18例、肝纤维化组(S1~S3期)73例、肝硬化组(S4期)29例。应用超声造影获取各组肝动静脉渡越时间(HAVTT1和HAVTT2)值,SWE检查获得肝脏弹性测值;应用受试者工作特征(ROC)曲线分析各检测指标预测肝纤维化及肝硬化的诊断效能。结果随着肝纤维化分期提高,HAVTT1、HAVTT2逐渐缩短,肝脏弹性测值逐渐增大;HAVTT1、HAVTT2及肝脏弹性测值在无纤维化组、肝纤维化组及肝硬化组之间两两比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,HAVTT1、HAVTT2诊断肝纤维化及肝硬化的曲线下面积分别为0.870、0.851和0.889、0.856,肝脏弹性测值诊断肝纤维化及肝硬化的曲线下面积为分别为0.953、0.898;肝脏弹性测值的诊断效能明显优于HAVTT1及HAVTT2,差异均有统计学意义(均P<0.05)。结论应用SWE技术获取的肝脏弹性值对CHB患者肝纤维化及肝硬化的诊断优于超声造影。     

计算机辅助诊断联合超声弹性成像技术对甲状腺结节的诊断价值研究

【摘要】目的：探讨计算机辅助诊断（CAD)联合超声弹性成像技术在鉴别甲状腺良恶性结节的应用价值。方法：选取2019年6月—2020年12月经手术或穿刺活检病理证实的甲状腺结节患者148例（共182个结节）,术前均由高年资超声医师判读,弹性成像分级,CAD系统基于ACR-TIRADS及K-TIRADS指南分析图像及三者联合诊断对甲状腺结节进行分类,以病理结果为金标准,评价其各自的诊断效能。结果:计算机辅助诊断系统,弹性成像技术和超声医师三者联合诊断的诊断效能最高,其灵敏度,特异度,准确度及AUC最高,与弹性成像联合CAD相比,与单一检查方法相比,差异均有统计学意义（P<0.05)。与高年资超声医师相比,无统计学差异。结论：计算机辅助诊断系统,弹性成像技术和超声医师判读三者联合运用在甲状腺结节良恶性的鉴别诊断中诊断效能可媲美高年资超声医师,诊断效能高于两者联合,高于运用单一检查方法。     

病毒性肝炎患者中柯萨奇B组病毒的感染情况调查

目的了解柯萨奇B组病毒(coxackie virus B, CVB)在病毒性肝炎中的感染情况.方法用免疫酶法对203例各型肝炎组进行CVB 1至6型免疫球蛋白G(IgG)检测,并与105例病毒性心肌炎组及正常对照组进行分析.结果肝炎组阳性率(39.9%)高于正常对照组(13.4%),P<0.005,而低于心肌炎组(53.3%),P<0.025,B1～6型都有一定的检出率,且以各型交叉感染为主.结论病毒性肝炎患者对CVB各型普遍易感,其致病性应引起重视与探讨.     

病毒性肝炎患者中柯萨奇B组病毒的感染情况

目的：了解柯萨奇B组病毒（coxackie virus B,CVB)在病毒性肝炎中的感染情况。方法：用免疫酶法对203例各型肝炎组进行CVB1至6型免疫球蛋白G（IgG)检测，并与105例病毒性心肌炎组及正常对照组进行分析。结果：肝炎组阳性率（39．9％）高于正常对照组（13．4％），P＜0．005，而低于心肌炎组（53．3％），P＜0．025，B1－6型都有一定的检出率，且以各型交叉感染为主。结论：病毒性肝炎患者对CVB各型普遍易感，其致病性应引起重视与探讨。     

剪切波弹性成像技术联合常规超声对最大径≤2 cm乳腺癌的诊断价值

目的 探讨剪切波弹性成像(SWE)技术联合常规超声对小乳腺癌(最大经≦2cm)鉴别诊断价值。方法：搜集171例,共177个小乳腺病变(最大径≦2cm),术前均行BI-RADS 分类及剪切波弹性检测,获得所有乳腺病变的剪切波定量参数,应用受试者工作特征(ROC)曲线确定Emax的诊断临界值,以病理为金标准,评价SWE联合常规超声的诊断效能并分析Emax对BI-RADS 4a类小乳腺病变良恶性的诊断价值。结果：177例≦2cm乳腺实性病变中,组织病理学检查为良性病变155个(87.57%),恶性病变22个(12.94%),恶性病变组的SWE定量参数均大于良性病变组,差异有统计学意义(P<0.05);Emax联合常规超声对评价小乳腺病变良恶性的ROC曲线面积小于常规超声;以Emax 87.5Kpa作为诊断临界值,BI-RADS 4a类病变中71例(75.53%)降为3类,其中包含5例恶性病变,BI-RADS 3类病变的假阴性率由0%上升到3.8%(P<0.05)。结论：Emax联合BI-RADS分类可以显著提高小乳腺癌诊断的特异度和准确度,减少在临床诊疗中4a类病变不必要的穿刺率和手术率,但是对于小于2cm的乳腺可疑恶性病变时,我们应该适当降低诊断临界值的的保守策略,从而降低假阴性率病例的出现。     

Surface gene mutations of hepatitis B virus among high-risk patients with occult hepatitis B virus infection

Surface gene mutants of hepatitis B virus (HBV) have been reported in a variety of patient groups. Because of limited data regarding these mutations in patients with occult HBV infections; we aimed to determine these mutations among high-risk patients with occult HBV infection. The presence of HBV-DNA was determined in patients with isolated anti-HBc by real-time polymerase chain reaction (PCR). Then, surface gene region was amplified by nested PCR and mutations were analyzed after sequencing. The mutations that resulted in nonfunctional hepatitis B surface antigen (HBsAg) were insertion of single nucleotide in 2 cases, which causes frameshift and single-nucleotide replacement, and premature stop codons at Leu15 and Gly10 in the other 2 cases. Amino acid substitution at amino acid position 207(S207N) was found in the other isolates. Our study suggested that “a” region mutations did not play a major role in HBsAg detection, and other genetic and nongenetic factors may be responsible for failure to detect HBsAg by routine laboratory tests.     

乙型肝炎病毒感染者血清抗核抗体的研究

目的探讨乙型肝炎(简称乙肝)病毒(HBV)感染者血清抗核抗体(ANA)特征及其与临床的相关性。方法收集慢性乙肝(CHB)、乙肝后肝硬化(LC)、肝癌(HCC)患者共376例,采用酶联免疫吸附试验检测ANA。结果 (1)376例患者中ANA阳性99例(26.3%),其中CHB组58例,占21.0%(58/276),LC组20例,占38.5%(20/52),HCC组21例,占43.7%(21/48);健康对照组ANA阳性2例,占3.0%(2/66)。3组均明显高于健康对照组;LC、HCC与CHB组比较,差异有统计学意义(P<0.01);LC组与HCC组比较,差异无统计学意义(P>0.05)。(2)CHB、LC和HCC组ANA以低滴度(1/100)为主,分别为72.4%(42/58)、65.0%(13/20)和71.4%(15/21)。(3)ANA滴度1/100和大于或等于1/320的丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、HBV-DNA各指标比较,差异无统计学意义(P>0.05)。结论 HBV感染者出现的自身抗体以ANA为主,HCC组阳性率最高。70.7%的HBV感染者ANA为低滴度阳性,对其滴度的高低与肝细胞损伤及HBV-DNA复制率无明显相关。     

Diagnostic significance of hepatitis B viral antigens in patients with glomerulonephritis-associated hepatitis B virus infection

Hepatitis B viral infection can lead to hepatitis B virus-associated glomerulonephritis, a clinically significant subtype of secondary nephritis. In the present study, we examined the presence of PreS1/S2 antigen in renal tissues by use of immunohistochemistry and investigated the use of PreS1/S2 and 2 HBV serum antigens, HBe-Ag and HBs-Ag, in the diagnosis. We assessed the presence of these 3 antigens in patients with confirmed hepatitis B virus-associated glomerulonephritis (n = 22) and patients without this disease (n = 19). Our results indicate that the combined use of PreS1/S2-Ag and serum HBe-Ag in the diagnosis of hepatitis B virus-associated glomerulonephritis had good positive predictive value (0.89), modest negative predictive value (0.77), and substantial agreement based on Cohen's kappa coefficient (κ = 0.660, P < 0.001). We suggest that our results be considered in the development of more definitive diagnostic criteria for hepatitis B virus-associated glomerulonephritis.     

流式细胞术检测淋巴细胞Fc受体及其对HBV感染者疾病诊断价值的研究

目的建立FcR标记检测方法，探讨FcR的表达在乙型肝炎慢性化过程中的作用。方法制备FITC标记的聚合IgG，标记淋巴细胞表面的FcR，应用流式细胞术分析急性和慢性乙型肝炎患者各病程时期FcR表达的阳性淋巴细胞百分率。结果慢性乙型肝炎患者FcR的表达较对照组和急性乙型肝炎康复患者显著低下（P〈0．01）；急性乙型肝炎患者急性发作期FcR阳性细胞百分率明显高于对照组（P〈0．01）；急性乙型肝炎应用干扰素（IFN）治疗1个月后及完全康复后FcR阳性细胞百分率与正常对照组相一致。结论流式细胞仪检测淋巴细胞FcR表达，有助于判断乙型肝炎患者的病情、估测预后和指导治疗。     

超声弹性成像在调整C-TIRADS 4类结节评级中的应用价值

目的 探讨实时超声弹性成像(RTE)在调整中国甲状腺影像报告和数据系统(C-TIRADS)4类结节评级中的应用价值。方法 回顾性分析2016年1月至2019年12月扬州大学附属医院72例患者82个C-TIRADS 4类结节的临床资料,所有患者术前均行常规超声及RTE检查,根据结节最大径将结节分成≤10 mm和＞10 mm两组。采用Asteria RTE评分法,将RTE评分＜3分结节的C-TIRADS分类下调一级;评分≥3分的上调一级。以手术病理结果为金标准,绘制RTE调整前、后C-TIRADS分类的受试者工作特征(ROC)曲线,并比较两者的诊断效能。结果 RTE调整前、后C-TIRADS分类诊断良恶性甲状腺结节的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为90.4%、56.7%、78.0%、78.3%、77.3%和96.2%、80.0%、90.2%、89.3%、92.3%;其ROC曲线下面积分别为0.735和0.881(Z=2.869,P=0.004)。RTE对≤10 mm组及＞10 mm组结节调整后的诊断灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为95.0%、80.0%、88.6%、86.4%、92.3%和96.9%、80.0%、91.5%、91.2%、92.3%。≤10 mm组及＞10 mm组结节RTE调整后的C-TIRADS分类对良恶性甲状腺结节的诊断效能均高于调整前,ROC曲线下面积分别为0.875和0.884,其中≤10 mm组RTE调整前后差异有统计学意义(Z=3.211,P=0.001)。结论 RTE对C-TIRADS 4类结节评级调整可显著提高其诊断效能,尤其对于≤10mm的C-TIRADS 4类结节。     

Incidence of hepatitis B virus infection in patients with blood disease

AIM: To define incidence of HBV infection in patients with blood diseases caused by blood components transfusion; correlation between infection rate and blood disease nosological entity, intensity of hemoreplacement therapy, time of hepatitis B incubation period in patients with hematological malignancies after the diagnosis and initiation of polychemotherapy (PCT). MATERIAL AND METHODS: In 2000-2007 a prospective clinicoepidemiological trial was made to detect markers of HBV infection among 303 patients 15 to 76 years of age treated in the department of acute leukemia chemotherapy of N.N. Burdenko Military Hospital for acute lymphoid and myeloblastic leukemia, chronic myeloid leukemia in a blastic crisis, myelodysplastic syndrome in blast transformation, lymphoproliferative diseases with bone marrow affection. Statistic processing was performed with standard methods. RESULTS: HBV infection markers were detected in 30 (9.9%) of 303 examinees. Among the infected patients there were 16 (53.4%) patients with different variants of acute myeloblastic leukemia, 12 (40.0%) with different immunophenotypes of acute lymphoblastic leukemia, 1 (3.3%) patient with acute biphenotypical leukemia and 1 (3.3%) with lymphoma/leukemia. HBV infection was registered in patients 2 to 32 months after the beginning of the treatment. Most of the patients - 23 (74%) of 30 - were infected with HBV within the first year after hematological diagnosis and PCT induction course. HBV was diagnosed within treatment year two in 5 (16%) patients and within year three after PCT in 3 (10%). CONCLUSION: High incidence of HBV infection in patients with hematological malignancies points to a high epidemiological risk of hemoreplacement therapy, unsatisfactory quality of donor blood testing and necessity of updating methods of donor infection detection. To lower the risk of HBV infection in patients with hematological malignancies it is necessary to perform vaccine prophylaxis of hepatitis B before PCT.     

Role of hepatitis B virus infection in alcoholic patients

Summary The aim of this study was to determine the incidence of HBV markers in patients with alcoholic liver disease and to compare the results with those of patients with non-alcoholic liver disease and control subjects. We tried to determine whether the association between alcohol intake and HBV infection increases the risk of developing severe liver disease. The results showed an increased incidence of HBsAg in alcoholic patients when compared with controls as well as an increased incidence of severe chronic liver disease in HBV-positive groups when compared with HBV-negative groups. We conclude that HBV infection is an important additional risk factor for the development of severe liver disease in alcoholic patients.     

超声弹性成像及TCT检查对宫颈病变的诊断价值比较

目的对比超声弹性成像及薄层液基细胞学检查(TCT)对宫颈病变的诊断价值。方法选择在本院进行宫颈癌筛查的178例高危妇女为研究对象,所有受试者均给予超声弹性成像及TCT检查,以病理结果为金标准,比较两种方法的诊断价值。结果在178例受试者中,病理诊断为CINⅠ级72例,CINⅡ级44例,CINⅢ级24例,宫颈癌38例。宫颈癌患者的超声弹性成像评分显著高于非宫颈癌患者(P<0.05)。TCT检查为非典型鳞状上皮细胞(AS-CUS)75例,低级别鳞状上皮内病变(LSIL)42例,高级别鳞状上皮内病变(HSIL)27例,宫颈癌34例。超声弹性成像及TCT对宫颈癌的诊断灵敏度分别为94.7%和86.8%,诊断特异度分别为100.0%和99.3%,阳性预测值分别为100.0%和97.1%,阴性预测值分别为98.6%和96.5%。结论超声弹性成像及TCT检查对宫颈病变的筛查效率都比较高,两种方法对于宫颈癌的诊断都有很好的诊断特异度,且诊断灵敏度、阳性和阴性预测值也比较高。     

Chinese herbal medicine reduces acute hepatitis exacerbation in patients with hepatitis B virus infection: A case-control study in Taiwan

ObjectivesLittle information is available about the impact of Chinese herbal medicine (CHM) treatment on acute exacerbation of hepatitis. This study aimed to assess the risk of acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma in HBV patients with and without CHM use.Design and settingThis population-based case-control study used data from the Taiwan Longitudinal Health Insurance Database from 2000 to 2013. Newly diagnosed HBV patients had acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma as the case group, while another patients had no acute exacerbation of hepatitis and cirrhosis and hepatoma as the control group. To correct the differences in sociodemographic factors and Western medication use between the two groups, propensity score matching was used at a 1:1 ratio, and resulted in a comparison of 1306 and 805 patients per group, respectively.Main outcome measuresOccurrence of acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma.ResultsOverall rate of acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma was 7.9% and 4.8%, respectively. Patients receiving CHM had a significantly lower risk of acute exacerbation of hepatitis (adjusted odds ratio [aOR] =0.20, 95% confidence interval [95%CI]: 0.13–0.31) and subsequent cirrhosis and hepatoma (aOR = 0.29, 95%CI: 0.18–0.49) than those not receiving CHM after adjusting for relevant covariates. However, no dose-dependent relationship was exhibited for either incidence of acute exacerbation of hepatitis and cirrhosis and hepatoma.ConclusionThese findings highlight that the use of CHM was associated with a significantly reduced risk of acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma in patients with HBV. Future research could further explore the benefit of CHM therapies for treatment of acute hepatitis exacerbation.     

不同病程T2DM患者采用实时超声弹性成像技术与能量多普勒超声对跟腱异常改变的诊断价值

目的：探讨不同病程T2DM患者采用实时超声弹性成像技术与能量多普勒超声对跟腱异常改变的诊断价值。方法：选取135例T2DM患者作为研究对象,研究时间为2017年2月至2020年2月,根据不同糖尿病病程分为A组(病程＜5年)、B组(病程5-10年)、C组(病程＞10年),各45例;其中,A组经MRI确诊为跟腱异常改变共10例,B组经MRI确诊为跟腱异常改变共14例,C组经MRI确诊为跟腱异常改变共17例。均予以实时超声弹性成像技术与能量多普勒超声检测,评估检测后的检出率、cut-off值、约登指数、敏感度、特异度,以及分析ROC曲线。结果：A组经能量多普勒超声检测后Ⅰ级为3例(6.67%)、Ⅱ级为0例、Ⅲ级为0例、0级为42例(93.33%),与金标准相比,存在显著差异(P＜0.05);B组经检测后Ⅰ级为5例(11.11%)、Ⅱ级为1例(4.44%)、Ⅲ级为0例、0级为39例(86.67%),与金标准相比,存在显著差异(P＜0.05);C组经检测后Ⅰ级为6例(13.33%)、Ⅱ级为2例(4.44%)、Ⅲ级为0例、0级为37例(82.22%),与金标准相比,存在显著差异(P＜0.05)。A组经实时超声弹性成像技术检测后3级为8例(17.78%)、1级为31例(67.39%)、2级为6例(13.33%),与金标准相比,无显著差异(P＞0.05);B组经检测后3级为12例(26.67%)、1级为26例(57.78%)、3级为7例(15.56%),与金标准相比,无显著差异(P＞0.05);C组经检测后3级为15例(33.33%)、1级为23例(51.11%)、2级为7例(15.56%),与金标准相比,无显著差异(P＞0.05)。 C组的RTE应变率比值显著高于A与B组(P＜0.05);B组RTE应变率比值显著高于A组(P＜0.05)。ROC曲线分析显示,能量多普勒超声、弹性成像分级法、RTE应变率比值的AUC分别为(0.707、0.927、0.541,P＜0.05),敏感度(41.50%、85.40%、22.00%),特异度(100.00%、100.00%、86.20%),约登指数(0.415、0.854、0.082)。结论：实时超声弹性成像技术与能量多普勒超声相比,前者诊断确诊率更高。     

超声弹性成像技术对精索静脉曲张患者应用价值的Meta分析

目的 采用Meta分析评价超声弹性成像技术对精索静脉曲张(VC)患者的诊断价值。方法 检索PubMed、Embase、web of science、Cochrane图书馆、中国知网(CNKI)、万方以及维普数据库,严格按照纳入及排除标准筛选文献、提取资料并根据NOS量表进行质量评价,运用ＲevMan5.3软件对数据进行Meta分析。结果 最终纳入15篇文献,包含980例左侧VC患者及524名健康对照者,其中7篇文献报道了共计504例左侧VC患者与248名健康对照者在使用SWE检查后的睾丸剪切波速度值SWV,Meta分析汇总结果显示：VC患者睾丸硬度减低[MD=-0.02,95%CI(-0.03,-0.01),P=0.0004],差异具有统计学意义;3篇文献报道了共计160例左侧VC患者和100名健康对照者在使用SE检查后的睾丸应变比SR,Meta分析汇总结果显示：VC患者睾丸硬度减低[MD=-0.01,95%CI(-0.13, 0.12),P=0.92],差异不具有统计学意义;5篇文献报道了共计316例左侧VC患者和176名健康对照者在使用SE检查后的睾丸应变均值Mean,Meta分析汇总结果显示：VC患者睾丸硬度减低[MD=0.36,95%CI(0.12, 0.61),P=0.003],差异具有统计学意义。结论 超声弹性成像技术可能会成为精索静脉曲张患者的重要辅助检查手段。