慢性肝炎肝静脉彩色多普勒超声频谱改变与肝纤维化分期相关性的研究

目的 探讨慢性肝炎肝静脉频谱改变与病理肝纤维化分期的相关性。方法 应用彩色多普勒超声检测了602例慢性肝炎患者的肝静脉，全部病例均经超声引导下肝组织活检病理证实，将其频谱改变与肝纤维化病理分期进行对照分析。结果 慢性肝炎的肝静脉频谱波型表现为双向、单向和连续平坦（门静脉样）三种类型；按纤维化程度分为轻度（S0-S1）、中度（S2～S3）和重度（S4），轻度和重度差异有统计学意义，中度和重度差异无统计学意义。将双向波型定为正常波形，单向、连续平坦波型定为异常波形；在正常与异常波形之间，各相邻纤维化分期之间无明显差异，仅S1与S4差异有统计学意义；无纤维化（S0）为对照组，有纤维化（S1～S4）为病变组，异常波形对肝纤维化诊断的敏感性17．3％（97／559），特异性90．7％（39／43），诊断准确性为34．2％（136／602），假阳性4例（9．3％），假阴性462例（82．6％）。S波峰值流速在单向与双向之间差异无统计学意义；a波峰值流速在S0、S1、S2、S3分别与S4之间差异有统计学意义，S0～S3各期之间差异无统计学意义，通过ROC分析，a波峰值流速以8cm／S为界值，诊断S4的敏感性为40．6％，特异度为51．3％。结论 单向频谱峰值流速不一定降低。肝静脉频谱形态及a波峰值流速对肝纤维化分期S3及以下各期无明确诊断意义，对S4期的诊断有较大的价值，a波峰值流速的敏感性明显高于频谱形态，诊断中应重视a波峰值流速的变化。在慢性肝病中，超声检测肝静脉频谱变化对肝纤维化的诊断具有一定的价值．

Correlation between the waveform changes of hepatic veins in patients with chronic hepatitis tested by color Doppler ultrasonography and the staging of liver fibrosis

Objective To investigate the correlation between the waveform changes of hepatic vein in patients with chronic hepatitis and the staging of pathological liver fibrosis. Methods The waveform changes of hepatic vein of 602 patients with chronic hepatitis were tested with color Doppler ultrasonography and comparatively analyzed with staging of pathological liver fibrosis. All the cases were identified by the liver pathological biopsy introduced with ultrasound. Results The waveform of hepatic vein of the patients shows three types, such as bi-directional waveform, unidirectional waveform, and completely flat (portal-like) waveform, and they were divided into mild (S0-S1), medium (S2-S3), and severity (S4) according to staging of pathological liver fibrosis. There was significant difference between mild and severity, but no significant difference between medium and severity. The bi-directional waveform was defined as normal waveform, but the unidirectional waveform and completely flat waveform defined as abnormal waveform. There was no significant difference among adjacent stages of fibrosis as well as between normal waveform and abnormal waveform, but only a significant difference between S1 and S4. The staging of no fibrosis (S0) was defined as the control group and the staging of fibrosis (S1-S4) defined as the patient group. The sensitivity of abnormal waveforms in diagnosing fibrosis was 17.3 %(97/559), the specificity was 90.7 %(39/43), the diagnostic accurate rate was 34.2 %(136/602), and there were 12 cases ( 8.2 %) with false positive and 462 cases ( 82.6 %) with the false negative. There was no statistical significance in the differences of flows of s peak value between the unidirectional waveform and the bi-directional waveform a, and a statistical significance in the differences of flows of a peak value between S0 and S4, S1 and S4, S2 and S4, and S3 and S4, but no statistical significance between S0 and S1, S1 and S2, and S2 and S3. Based on the ROC analysis, the limit value of a peak value was 8 cm/s. Its sensitivity in diagnosing S4 was 40.6 %, and specificity was 51.3 %. Conclusions The flow of peak value of the unidirectional waveform is not always decreased. The waveform pattern of hepatic vein and flow of a peak value have no definite diagnostic significance at S3 and below, but have a great value in the diagnosis of S4. The sensitivity of a peak value flow is higher than that of the waveform pattern. So, attention should be paid to the changes of a peak value flow in the diagnosis of liver fibrosis. The waveform changes of hepatic vein tested by color Doppler ultrasonography have a definite value in the diagnosis of liver fibrosis in the patients with chronic liver disease.