代偿期肝硬变肝组织结构及病变程度对超声诊断的影响

目的；分析代偿期肝硬变肝组织病变组织及程度的不同对超声诊断的影响。方法：采用多普勒超声，血清及病理检测了179例慢性肝炎及48例代偿期肝硬变患者。经统计学分析在44项超声检测指标中筛选出三项评价肝纤维化意义最大的独立性判别指标，以此三项指标判别肝硬变，对超声诊断出现假阴性及假阳性者进行分析，并对照分析其病理及血清学特点。结果：超声诊断出现假阴性者均为活动性肝硬变患者，肝组织炎症较明显，纤维隔较细小而疏松，假小叶结节小且均匀，血清肝纤维化标志物水平明显升高，声像学改变不明显。超声诊断出现假阳性者，炎症程度较假阴性组轻，血清肝纤维化标志物水平较假阴性组低，肝细胞呈灶性大泡性脂肪变性，或纤维隔宽且致密，肝实质回声紊乱。结论：超声诊断代偿期肝硬变可因肝组织病变结构及病变程度不同，出现假阴性及假阳性结果。

Influencing of Histological Features and Severity of Compensated Liver Cirrhosis on the Diagnosis of Ultrasonography

Objective:To Analysis the influencing of histological features and the severity of compensated liver cirrhosis on the diagnosis of ultrasonography Methods:One handred and seventy nine cases of chronic hepatitis and 48 cases of compensated liver cirrhosis were examined by three modalities including Doppler ultrasound, serum markers of fibrosis examination and liver histology Three independent variables were identified from 44 ultrasonographic parameters by statistic analysis These independent variables were used to discriminate liver cirrhosis and the results were compared with serological and liver histological findings Results:The diagnostic accuracy sensitivity and specificity of ultrasonography in compensated liver cirrhosis were 80 7%,62 5 % and 86 6% respectively There were false positive and negative results when making diagnosis of compensated liver cirrhosis by ultrasonography The inflammation degree and the level of serum fibrosis markers were higher in the group of false negative than in the group of false positive The abnormality of ultrasound manifestations were not obvious in patients of active liver cirrhosis with small and sparse fibrous septum or small and equal size psuedolobule nodes, so false negative diagnosis might occur When there were focal large bubble fatty degeneration of hepatic cells or wide and compacting fibrous septum in portal areas in patients of chronic hepatitis, the liver parenchymal echo might become coarse and heterogenous , which might cause false positive diagnostic results of ultrasonography Conclusions:The histological features and the severity of compensated liver cirrhosis can affect the diagnostic accuracy of ultrasonography