脂肪肝对超声诊断肝纤维化的影响

Influence of fatty liver on ultrasonic diagnosis for hepatic fibrosis

目的：探讨不同程度脂肪肝对超声诊断肝纤维化的影响。方法回顾性分析我院363例肝病患者,均经肝穿刺活检确诊为肝纤维化，病理分期为S1-S4四期，其中脂肪肝患者223例，无脂肪肝患者140例，按纤维化分期及脂肪肝分度，分别观察肝脏实质回声的改变，采用秩和检验的统计学方法，分析不同程度脂肪肝对肝纤维化超声诊断结果的影响。结果轻度脂肪肝对各程度肝纤维化超声诊断结果的影响差异无统计学意义（P〉0.05），中、重度脂肪肝使诊断的准确率下降，中度脂肪肝与无脂肪肝组比较，在S1-S2期差异有统计学意义（P〈0.05），重度脂肪肝与无脂肪肝组比较，在S1-S3期差异有统计学意义（P〈0.05），S4期的诊断受肝细胞脂肪变性的影响较小，差异无统计学意义（P〉0.05）。结论不同程度脂肪肝对超声诊断肝纤维化存在影响，并可能使诊断结果偏轻于病理结果。

Objective To study the influence of fatty liver in different degree on ultrasonic diagnosis for hepat-ic fibrosis. Methods Three hundred and sixty-three patients with liver diseases who were identified hepatic fibrosis S1-S4 with liver biopsy were retrospectively analyzed. There were 223 cases in the steatosis group and 140 cases in the non-steatosis group. The changes of liver parenchyma echo were observed respectively according to the stage of fi-brosis and the degree of fatty liver. Rank sum test was used to analyze the influence of fatty liver in different degree on the accuracy of ultrasonic diagnosis for hepatic fibrosis. Results The influence of mild fatty liver on various de-grees of hepatic fibrosis ultrasonic diagnosis results was not statistically significant （ P〉0.05）. Moderate and severe fatty liver made diagnostic accuracy rate declined. The diagnostic accuracy rate of moderate fatty liver showed statistical significance in S1-S2 （P〈0.05） and severe fatty liver showed statistical significance in S1-S3 （P〈0.05） compared with non-fatty liver group. Diagnosis of hepatic fibrosis in S4 was less affected by hepatic steatosis. The difference had no statistical significance in S4 （P〉0.05）. Conclusion Fatty liver in different degree has influence on the diagnosis of hepatic fibrosis with ultrasonography, and may make the diagnosis results relatively less severe than the pathological results.