高频超声观察肝实质形态的改变对慢性肝病肝纤维化分期的价值

Morphological changes of hepatic parenchyma in staging of liver fibrosis in patients with chronic liver diseases by high frequency ultrasound

目的探讨通过高频超声观察慢性肝病肝实质回声形态改变对肝纤维化分期的诊断价值。方法正常对照组(S0)57例,病例组403例(其中S1、S2、S3、S4或肝硬化分别为118例、97例、112例、76例),应用高频超声观察肝实质回声形态在各纤维化分期之间的改变,将观察的结果与肝组织病理纤维化分期(S)进行对照分析。结果将慢性肝病肝实质形态分为细颗粒、较粗颗粒、粗颗粒、窄条纹、宽条纹或网格状共五个级别。S0、S1期中,多表现为细颗粒、较粗颗粒,S0与S1之间无显著性差异;S2、S3、S4期中,分别以粗颗粒、窄条纹、宽条纹或网格状所占百分比最高,分别为62.9%(61/97)、70.5%(79/112)、69.7%(53/76),S0～S1与S2、S2与S3、S3与S4之间均有显著性差异。通过肝实质形态对肝纤维化诊断的敏感性为87.8%(354/403),特异性分别为87.7%(50/57),诊断的正确率为87.8%(404/460)。经Spearman相关分析,肝实质形态与S分期的相关系数是0.909。结论通过高频超声观察肝实质形态的改变,对肝纤维化分期的判断具有重要的诊断价值。

Objective To explore the value of the morphological changes of hepatic parenchymal echo in patients with chronic liver diseases to staging of liver fibrosis evaluated with high frequency ultrasound. Methods The ultrasonographic data of 57 normal subjects and 403 cases of chronic liver disease （including 118 cases in S1 , 97 cases in S2, 112 cases in S3 and 76 cases in S4 respectively） were described. The morphological changes of hepatic parenchymal echo were observed, and the resuits were comparatively analyzed with staging （S） of pathological live fibrosis. Results The morphological appearances of hepatic parenchyma in the patients were divided into 5 stages such as thin granule （S0）, moderate coarse granule （S1）, coarse granule （S2）, narrow streak （S3）, wide streak or recticulum （S4）. In groups of So and S1 , most of the appearances of hepatic parenchyma presented thin granule and moderate coarse granule, and there was no significant difference between So and S1. But in groups of S2, S3 and S4＋ the percentages of coarse granule, narrow streak, and wide streak or recticulum were 62.9% （61/97）, 70.5% （79/112）, and 69.7% （53/76） respectively. There were significant differences among the groups of S0, S1 and S2, S2 and S3, S3 and S4. In the diagnosis of liver fibrosis via the morphological appearances of hepatic parenchyma, the sensitivity was 87.8% （354/403）, the specificity was 87.7% （50/57）, and the accuracy was 87.8% （404/ 460）. The correlation coefficient of the appearances of hepatic parenchyma and staging is 0. 909. Conclusion The morphological changes of hepatic parenchyma have an important diagnostic value in determining the stages of liver fibrosis.