背向散射积分技术在肝纤维化及早期肝硬化诊断中的应用价值

INTEGRATED BACKSCATTER TECHNIQUES IN THE DIAGNOSIS OF LIVER FIBROSIS AND EARLY CIRRHOSIS OF THE LIVER

目的探讨超声背向散射积分(IBS)技术在肝纤维化及早期肝硬化诊断中的应用价值。方法应用HP5500彩色多普勒超声诊断仪检测42例正常人及114例慢性乙型病毒性肝炎患者(无肝纤维化40例、肝纤维化36例、早期肝硬化38例)肝实质近场、中场、远场的IBS值,结合病理结果进行对比分析。结果各组肝脏近、中、远场的IBS值比较:肝纤维化组及早期肝硬化组肝脏近场、中场、远场的IBS值较正常对照组增加,组间两两比较差异有统计学意义(P<0.05),肝炎组、肝纤维化组、早期肝硬化组中肝脏近场、中场、远场的IBS值均表现为依次增高,组间两两比较,差异有统计学意义(P<0.05)。同一组内不同区域IBS值比较:对照组、肝炎组各组内肝脏近场、中场、远场IBS值比较依次降低,两两比较差异有统计学意义(P<0.05);肝纤维化组、早期肝硬化组肝脏中场IBS值高于近场及远场,且二组内近场IBS值高于远场,两两比较差异有统计学意义(P<0.05);通过ROC曲线分析,肝脏近、中、远场IBS值分别为29.71,35.82,25.16dB时,诊断肝纤维化的敏感度分别为86.7%、97.2%、97.2%;特异度分别为66.7%、68.3%、68.3%;肝脏近、中、远场IBS值分别为34.85、38.04、31.32dB时,诊断肝硬化的敏感度分别为97.4%、97.4%、92.1%,特异度分别为85.6%、81.4%、85.6%;肝脏近、中、远场IBS与肝纤维化分期的相关系数分别为:0.889、0.916、0.911,差异有统计学意义(P<0.01)。结论 IBS技术能反映出肝实质纤维化的病理改变,同时能做出量化分析,为临床提供一种无创诊断肝纤维化的检查方法。

Objective To study the clinical diagnosis value of integrated backscatter fIBS） technique for liv- er fibrosis and early cirrhosis. Methods We selected 114 patients with chronic viral hepatitis B （ no liver fibrosis 40 cases, with liver fibrosis 36 cases, with early liver cirrhosis 38 cases） and normal people 42 ca- ses, HP5500 color ultrasonic instrument was used to detect their IBS value, including near of liver, mid- field of live and far field of liver, all of them were analyzed combined with the pathological results. Results The near field and far between liver IBS value comparison： liver IBS value of near far field of liver fibrosis group and early cirrhosis group were increased compared with normal control group, there were significant differences between the any two groups（P〈0.05）, IBS value near far fiend in hepatitis group, hepaticfi brosis group and early livercirrhosis group were also increased, there were significant differences between the any two groups（P〈0.05）. Compared the value of the same group between different regions of IBS. liver IBS value was decreased in the order of far field control, the difference was statistically significant （ P〈0.05）, the early stage of liver fibrosis in liver cirrhosis group midfielder IBS was higher than the value of the near field and far field and near field IBS in the two groups was higher than the value of the far field, the difference was statistically significant（P〈0.05}. Through the analysis of ROC curve, near the far field IBS value were 29.71dB, 35.82dB, 25.16dB respectively; Sensitivity of diagnosing hepatic fibrosis were 86.7%, 97.2%, 97.2% respectively; Specificity were 66.7%, 68.3%, 68.3%. IBS value near the far field were 34.85dB, 38.04dB, 31.32dB respectively; Sensitivity for the diagnosis of liver cirrhosis were 97.40/oo, 97. 4%, 92. 1%, specificity were 85. 6%, 81.4%, 85.6%. The correlation coefficient in the staging of liver fibrosis of the liver in the far field IBS were 0. 889, 0. 916, 0. 911 respectively,the differ- ence was statistically significant（P〈0.01）. Conelusions IBS technology can reflect the pathological chan- ges of liver fibrosis, at the same time can make quantitative analysis. It provides a non- invasivediagnosis of liverfibrosis inspection method for clinical.