灰阶及彩色多普勒超声在区分慢性病毒性肝炎和早期代偿期肝硬化的应用价值

Gray and Color Doppler Ultrasonography in differentiation between chronic viral hepatitis and compensated early stage cirrhosis

目的:探讨灰阶及彩色多普勒超声用以区分慢性病毒性肝炎和早期代偿期肝硬化的诊断价值。方法:正常对照组32例,病例组72例(44例慢性病毒性肝炎和28例早期代偿期肝硬化患者),病例组病人均作肝穿刺活检。在二维灰阶及彩色多普勒超声下对门静脉、肝动脉和脾脏进行多种定性和定量变量研究,如门静脉直径/最大流速、门静脉直径/平均流速、肝动脉与门脉的时间平均流速之比值等。结果:ROC曲线分析表明:肝门静脉充血指数、门静脉直径/时间平均流速和肝动脉与门静脉的时间平均流速之比在区分慢性病毒性肝炎和早期代偿期肝硬化有较好的灵敏度和特异度。利用对肝脏的三个定性变量和四个定量变量可正确地划分88.9%的原始病例。在对慢性病毒性肝炎患者的穿刺活检结果中发现肝纤维化的第5期和第1～4期比较有显著性差异。结论:慢性病毒性肝炎病人肝纤维化的第5期与第1～4期相比,血流动力学参数有显著不同。利用二维灰阶及彩色多普勒超声得到的指标区分慢性病毒性肝炎和早期代偿期肝硬化是可行的。这些指标可用于监测慢性病毒性肝炎的发展,并可避免不必要的活检。

Objective：To assess the value of Gray scale （GS） and Colour Doppler Ultrasonography （CDU） in differentiating theprogression of chronic viral hepatitis （CVH） and compensated liver cirrhosis （CIR）. Methods：Seventy-two patients and 32 normal individuals used as controls were studied. Forty-four patients suffered from CVH and 28 from CIR. All patients underwent liver biopsy. Multiple qualitative and quantitative variables were studied with GS and CDU in the Liver, Portal Vein （PV）, Hepatic Artery （HA） and spleen. On the basis of the obtained Doppler data several known indexes were calculated. Alternative indexes [PV diameter （D）/time average maximum velocity （VMAX）, PV diameter/time average mean velocity （VTAM）, HA/PV VTAM ratio] derived from them were calculated. Results：ROC analysis showed that PV congestion index, PV D/VTAM and HA/PV VTAM indexes had the best sensitivity and specificity in discriminating CVH from CIR. Stepwise discriminant analysis selected as significant predictors 3 qualitative and 4 quantitative variables that correctly classify 88.9% of the original grouped cases. In CVH patients that underwent biopsy we found statistically significant changes in those at fibrotic stage 5 compared to fibrotic stages 1-4. Conclusion：We find significant differences in haemodynamic parameters and indexes for CVH patients at fibrosis stage 5 compared to all other stages. Simple GS and CDU parameters may discriminate CVH from CIR. The alternative Doppler indexes suggest that accurate differentiation between CVH and CIR is possible. These indexes could be useful for monitoring CVH and avoiding unnecessary biopsies.