超声判别慢性肝病肝纤维化分期与病理背离问题探讨

Deviation of fibrosis staging in patients with chronic liver diseases observed with ultrasonography from the pathological results:a discussion

目的探讨超声判别慢性肝病肝纤维化分期与病理诊断之间背离的原因。方法693例肝病患者经超声引导肝组织取活检,按病理结果分为无肝纤维化(S0)到肝硬化(S4)五期,S0133例,S1166例,S2150例,S3142例,S4102例,其中按是否含脂肪变性分为脂肪变性组(107例)与非脂肪变性组(586例)。双盲方法,肝穿前或后7d内进行超声常规检查,将超声检查结果与病理结果进行比较。结果肝纤维化分期超声与病理背离238例,占全部检测病例34.3%(238/693)。脂肪组、非脂肪组之间超声与病理背离差异无统计学意义,均主要发生在S1期,脂肪组S1期22例,占同期62.9%(22/35),非脂肪组S1期90例,占同期68.7%(90/131)。肝脂肪变性含量<50%有96例,47例超声与病理背离,占48.9%(47/96);肝细胞脂变含量≥50%有11例,有9例与病理背离,占81.8%,均在S3以下,其中2例S4期肝细胞脂变>70%,超声与病理相符。6例不含脂肪变性病例,超声有S3～S4期表现,病理S0期2例,S1期4例。结论超声判别肝纤维化分期的准确性不仅受纤维化程度的影响,也与肝纤维化结节类型及是否存在脂肪变性有关。

Objective To investigate the cause of deviation of fibrosis staging in patients with chronic liver diseases observed with ultrasonography from the pathological results. Methods The 693 patients with liver diseases were identified with liver biopsy guided with ultrasound, and the histological results of the biopsy samples are divided into 5 stages ranging from So （ no liver fthrosis） to S4 （liver cirrhosis）. There were 133 in So, 166 in S1, 153 in S2, 141 in S3, and 102 in S4. Also, they were divided into the steatosis group （ 107 cases） and non - steatosis group （586 cases） according to whether steatosis or not in their samples. The liver biopsy was conduced within 7 days before and after the conventional ultrasound examination, and the fibrosis staging with ultrasonography were compared with the liver biopsy results with the double blind method. Results There was a deviation of the liver biopsy results from the fibrosis stating with ultrasonography in 238 cases, counting for 34.3 % of the total cases. There was no significant difference in the deviation of the fibrosis staging with ultrasonography from the pathological results between the steatosis group and the no - steatosis group. The deviation mainly occurred in S1 . There were 32 cases in S1 in the steatosis group, counting for 62.9% （22/35）; 90 cases in S1 in the no-steatosis group, counting for 68.7 % （90/131 ）. There were 96 cases with 〈 50% of liver steatosis content, but 47 cases in deviation from fibrosis staging with ultrsonography, counting for48.9% （47/96）, 11 cases with ≥50% of liver cell steatosis content, but 9 cases in deviation from fibrosis staging with ultrasonography, counting for 81.8% （9/11）, and all the 9 cases were under S3, the other 2 cases in S4 were with〉 70% of liver steatosis content, deviating from fibrosis staging with ultrasonography. There were 6 cases without liver steatosis, manifesting S3 - S4 in the ultrasonography; identified with liver biopsy, 2 cases in So and 4 cases in S1 . Conclusions The difficulty of staging of liver fibrosis with ultrasonography is in S1 , as the proliferative fibrous tissue is limited in the portal area, and the resolving power of the current ultrasonic diagnostic apparatus is too low to identify it. Otherwise, liver steatosis （ ≥50% ）, the type of liver cirrhosis nodule and the limitation of pathological samples are the important factors to influence the accuracy of staging liver fibrosis with ultrasonography.