超声检测慢性肝病患者肝中静脉的临床意义

Clinical research of B-mode ultrasonography detecting middle hepatic vein in chronic liver disease

目的探讨B型超声检测肝中静脉内径在慢性肝病患者中的临床应用价值。方法80例慢性肝病患者在接受肝穿刺活组织检查的同时，采用B型超声检测肝中静脉内径，用ROC随线分析肝中静脉内径诊断肝硬化的强度。结果肝硬化患者肝中静脉内径[（3.82±1.84）mm]小于慢性肝炎患者[（6.15±1.67）mm]（P〈0.01），失代偿性肝硬化患者肝中静脉内径[（2.98±51.15）mm]小于代偿性肝硬化患者[（4.42±2.20）mm]（P〈0.05）；随着肝纤维化分期的增加，肝中静脉内径逐渐缩小，两者呈负相关关系（rs=-0.465），肝中静脉内径诊断肝硬化的截断点为4.7mm，ROC曲线下面积（AUC）达到0.813（P〈0.01），其灵敏度为67.5％，特异度为90.0％，阳性预测值为88.0％，阴性预测值为73.5％，Youden指数为57.5％。结论B型超声检测肝中静脉内径对慢性肝病有一定的辅助诊断价值。

Objective To investigate the diagnostic value of B-mode ultrasonography in detecting middle hepatic vein（MHV） in chronic liver disease patients. Methods 80 chronic liver disease patients were divided into 2 groups（chronic hepatitis and liver cirrhosis）. Liver biopsies and the inner diameter（ID） of MHV was detected with B-mode ultrasonography. The ID of MHV was compared in the chronic hepatitis and liver cirrhosis groups, different liver fibrosis stages and compensation/non-compensation liver cirrhosis. The ability of ID of MHV in auxiliary diag- nosis liver cirrhosis was analyzed with the receiver operating characteristic curve（ROC）. Results The size of ID of MHV in liver cirrhosis （3.82±1.84）mm was smaller than that of chronic hepatitis （6.15±1.67）mm （P 〈 0.01 ）. The size of ID of MHV in non-compensation liver cirrhosis （2.98±1.15）mm was smaller than that of compensation liver cirrhosis （4.42±2.20）mm（P〈 0.05）. There was midrange negative correlation with liver fibrosis stages and the ID of MHV（ rs = - 0. 465, P 〈 0.01 ）. The cutoff point of ID of MHV diagnosis liver cirrhosis was 4.7mm. The area under ROC （AUC） achieved 0.813 （ P 〈 0.01 ）. The sensitivity （ Se）, specificity （Sp）, positive predictive value （PPV）, negative predictive value（NPV） and Youden index were 67.5 % , 90.0 % , 88.0 % , 73.5 % and 57.5 % , respectively. Conclusion There is well clinical value with B-mode ultrasonography detecting ID of MHV for the auxiliary diagnosis of chronic liver disease.