彩色多普勒超声判断慢性乙型肝炎肝纤维化程度的临床研究

Study on color doppler ultrasonograph used for judging severity of hepatic fibrosis caused by chronic hepatitis B

目的探讨彩色多普勒超声对慢性乙型肝炎肝纤维化程度判断的临床应用价值。方法对196例慢性乙型病毒性肝炎患者行彩色多普勒超声检查,观测其门静脉内径(Dpv),门静脉峰值流速(PVVmax)、肝固有动脉峰值流速(HAVmax)、肝静脉频谱改变、脾动脉搏动指数,并计算肝动脉峰值流速与门静脉峰值流速比(A/P)和肝循环指数(HCI),并与病理组织学检查结果进行比较。结果Dpv、PV-Vmax、HAVmax、肝静脉频谱变化在肝纤维化S4期与其他各期差异有统计学意义,P<0.01或<0.05,在S0、S1、S2、S3期间差异无统计学意义,P>0.05。A/P、HCI在纤维化程度轻度(S0-S1)、中度(S2-S3)和重度(S4)间差异统计学意义,均P<0.01。结论彩色多普勒超声检查在慢性乙型肝炎肝纤维化程度的判断上有重要临床价值,其中A/P及HCI两项指标能较准确地反映慢性乙型肝炎肝纤维化程度,可作为慢性乙型肝炎肝纤维化程度判断的重要指标。

Objective To investigate the value of Color Doppler ultrasonograph used for judging the severity of hepatic fibrosis caused by Chronic hepatitis B. Methods Color Doppler ultrasonograph was performed on 196 cases of chronic hepatitis B to observe the Dpv, PVVmax, HAVmax, hepatic vein Doppler waveform and SPPI, and calculate the values of the A/P and HCI, in comparison with the histopathologic findings. Results There were significant differences in Dpv, PVVmax, HAVmax and hepatic vein Doppler waveform between stage S4 and the other varying stages, P 〈 0.01 or 〈 0. 05, while no marked differences were noted between stage SO, S1, S2 and S3, all P 〉 0. 05. There were considerable differenees in A/P and HCI between mild （ S0-S1 ）, moderate （ S2-S3 ） and severe （S4） hepatic fibrosis groups, all P 〈 0.01. Conclusion Color Doppler ultrasonograph possesses the critical value in judging the severity of hepatic fibrosis caused by chronic hepatitis B; The indices such as A/P and HCI can acurrately refect the severity of the hepatic fibrosis caused by Chronic hepatitis B, and be acted as the important indices used for judging the severity of hepatic fibrosis.