超声量化指标对慢性肝炎肝纤维化的诊断价值研究

Evaluation of the Value of Ultrasonography in the Diagnosis of Liver Fibrosis in Chronic Hepatitis B Patients

目的探讨超声量化指标对慢性乙型病毒性肝炎(乙肝)患者肝纤维化的诊断价值。方法采用超声检测448例慢性乙肝患者,并与病理诊断结果对比,确定对慢性乙肝肝纤维化的诊断价值较大的超声量化指标。结果脾脏长径、胆囊壁厚度、脾脏厚度、门静脉主干内径、脾门静脉内径5项指标与肝纤维化程度呈正相关(r值分别为0.501、0.496、0.491、0.334和0.160,P均<0.01);且肝纤维化程度不同,患者上述指标间差异有统计学意义(P<0.05),其中,脾脏长径、脾脏厚度对判断肝纤维化≥S2期尤其是≥S3期的严重肝纤维化较有诊断意义〔受试者工作特征曲线(ROC)下面积分别为0.751与0.757,0.794与0.786〕,而胆囊壁厚度对判断肝纤维化≥S3期的严重肝纤维化较有诊断意义(ROC下面积为0.804)。结论超声检测脾脏长径、脾脏厚度、胆囊壁厚度是诊断肝纤维化较有价值的指标,适用于随访复查。

Objective To discuss the diagnostic value of ultrasonography（US） for detecting the severity of hepatic fibrosis in chronic hepatitis B patients.Methods 448 chronic hepatitis B patients were evaluated by US.The results of US were compared with the results of pathological diagnosis to determine the most valuable factor for diagnosing hepatic fibrosis in chronic hepatitis B patients.Results The spleen length（SPL）,gall-bladder wall thickness,spleen thickness（SPT）,internal diameter of portal vein and the internal diameter of splenic vein showed a positive correlation with liver fibrosis level（P0.01）,spearman correlation coefficient（r） were 0.501,0.496,0.491,0.334 and 0.160 respectively,and all these parameters showed statistics differences among patients with different hepatic fibrosis levels（P0.05）.SPL and SPT had important significance in diagnosing patients in ≥S2 stages especially in S3（Area under receiver operating characteristic curve（AUROC） were 0.751 and 0.757,0.794 and 0.786） while gall-bladder wall thickness had important significance in diagnosing patients in ≥S3 stages（AUROC were 0.804）.Conclusion SPL,SPT and gall-bladder wall thickness are valuable parameters for the diagnosis of hepatic fibrosis,and it is applicable to follow-up survey.