联合超声学指标无创诊断慢性乙型肝炎早期肝硬化

目的找出区别于肝纤维化（S0-3）及早期肝硬化（S4）的超声学指标,建立一个无创诊断早期肝硬化的模型,并评估模型的诊断效果。方法选取肝穿刺活检确诊的慢性乙型肝炎（CHB）患者99例,其中男性79例,女性20例;年龄18～61岁,平均年龄41.83岁。均行超声检查。收集的指标包括反映肝、脾的大小和血流动力学的指标,患者的年龄和性别,找出有意义的指标,建立一个诊断模型。统计分析的方法包括单因素分析、logistic多因素分析及接受者操作特征（ROC）曲线等。结果脾脏的厚径和脾动脉收缩期峰速/舒张期末流速之比（S/D）2个指标最后经筛选进入了模型,该数学模型诊断早期肝硬化（S4）指数（ECI）=logit P（y=肝硬化）=-14.965＋1.401×脾脏厚径＋2.883×脾动脉S/D,选取合适的阈值,灵敏度和特异度分别为100.00%和78.10%。结论超声学指标的数学模型对早期肝硬化的诊断有一定的临床价值,但尚需进一步验证。

Non-invasive ultrasonographic indexes in early hepatic cirrhosis of chronic hepatitis B

Objective To evaluate the diagnostic accuracy of a panel of ultrasonographic indexes in chronic hepatitis B（CHB） patients,and establish a predictive algorithm for differentiating liver fibrosis（S0-3） from early hepatic cirrhosis（S4）.Methods A total of 99 patients with CHB confirmed by liver biopsy were enrolled,male 79,female 20,aged 18-61 years old,mean age 41.83 years old.The ultrasound examination was performed and data of ultrasonographic indexes（size,homodynamic of liver and spleen）,age and sex of patients was collected.The predictive algorithm was built then combined these most informative indexes to assess the liver fibrosis stages.Statistical analysis methods including unvaried analysis,logistic multivariate analysis and receiver operating characteristic（ROC） curves were performed.Results The spleen width,systolic to diastolic ratios（S/D） of the spleen artery were selected into the best predictive accuracy for S4.Based on 2 indexes,early hepatic cirrhosis index（ECI）=logit P（y=S4）=-14.965＋1.401 ×spleen width＋2.883×spleen artery S/D.The sensitivity and specificity of diagnosing the early hepatic cirrhosis（S4） were 100.00 % and 78.10 % respectively in appropriate threshold.Conclusion It is demonstrated that the mathematical model is helpful and valuable to diagnose the early hepatic cirrhosis,but a great number of samples are further needed to verify it.