超声造影对肝硬化和肝纤维化的应用价值

Application Value of Contrast-enhanced Ultrasound for Liver Cirrhosis and Liver Fibrosis

目的:评估超声造影对于肝硬化和肝纤维化的临床应用价值。方法:选取2011年5月至2013年5月在我院接受诊治的慢性病毒性肝炎患者32例,其中肝纤维化24例,肝硬化12例,均经过超声造影下的肝功能检测和肝穿刺病理证实。另选取10例到我院经检查身体健康的志愿者作为对照组,无任何肝脏病史。采用实时灰阶造影,经肘静脉注射造影SonoVue,记录测定造影剂进入肝静脉到达时间(HVAT)、肝动脉到达时间(HAAT)及肝动静脉渡越时间(HAVTT)。结果:肝纤维化组超声造影剂到达肝静脉的时间较对照组明显延长,肝硬化组较对照组和肝纤维化组的超声造影剂到达肝静脉的时间要明显缩短,差异符合统计学意义(P<0.05);造影剂到达肝动脉的时间组间比较无统计学差异;肝硬化组肝动静脉渡越时间(HAVTT)较对照组时间明显缩短,组间比较具有统计学差异(P<0.05);HAVTT随着肝纤维化程度的升高而缩短,中、重度肝纤维化患者的时间缩短较明显,差异具有统计学意义(P<0.05)。结论:超声造影在肝硬化和肝纤维化诊断上具有一定的临床诊断价值,尤其是对于诊断肝纤维化程度具有重要的参考价值,可以更好地指导临床治疗,但是对于轻度的肝纤维化的诊断的准确性上有些缺陷。

Objective： To estimate the clinical application value of contrast-enhanced ultrasound for liver cirrhosis and liver fibro- sis. Methods： 32 cases with chronic viral hepatitis who were diagnosed in our hospital from May 2011 to May 2013 were selected which including 24 cases with liver fibrosis and 12 cases with liver cirrhosis. All the patients were confirmed by pathological liver function test and liver biopsy under contrast-enhanced ultrasound. Another 10 healthy volunteers without any history of liver disease who have been inspected in our hospital were selected to be the control group. The real-time gray-scale imaging and the elbow intravenous contrast SonoVue were used to determine and record the time of the contrast agent getting into the hepatic vein arrival （HVAT）, time of the con- trast agent getting into hepatic artery arrival（HAAT） and the transit time between the hepatic artery and vein（HAVTT）. Results： The time for ultrasound contrast agents arriving in hepatic vein in hepatic fibrosis group was significantly prolonged than that of the control group. The time for ultrasound contrast agents arriving in hepatic vein in liver cirrhosis group was significantly shortened than those of the con- trol group and the liver fibrosis group with statistically significant difference（P〈0.05）. There was no statistically significant difference ex- isting at the arrival of ultrasound contrast agents to hepatic artery among three groups. There was statistically difference of hepatic arteri- ovenous transit time （HAVTT） among three groups （P〈0.05）. The time was significantly shorter in liver cirrhosis group than that of the control group. HAVTT was shortened along with the rising of liver fibrosis degree in which the moderate and severe were shortened ob- viously with statistically significant differences（P〈0.05）. Conclusion： Contrast-enhanced ultrasound has certain clinical diagnosis value in the diagnosis of liver cirrhosis and liver fibrosis, and is especially important for diagnosis of degree of liver fibrosis, which can better guide the clinical treatment. However, it has some defects on the accuracy of diagnosis of hepatic fibrosis.