B超在肝囊型包虫病诊断中的临床价值分析

Clinical value of B-mode ultrasonography in the diagnosis of hepatic cystic hydatid disease

目的探讨B超在肝囊型包虫病诊断中的临床应用价值。方法选择2017年6-7月在西藏自治区那曲市大型包虫病筛查中接受肝囊型包虫病筛查的疑似肝囊型包虫病患者400例,患者均接受CT检查、B超检查,由2名CT诊断经验丰富的医师和2名超声诊断经验丰富的医师阅片,分析患者的CT图像、B超图像,作出诊断,以手术或血清学检查结果(临床确诊结果)为参照,计算和比较CT、B超对肝囊型包虫病的诊断灵敏度、特异度、准确性,并采用一致性检验,对CT、B超对肝囊型包虫病的诊断结果与临床确诊结果之间的一致性进行分析。根据临床确诊结果,将确诊肝囊型包虫病患者分为单纯囊肿型、多发囊肿型、子囊孙囊型、囊肿钙化型、囊肿实变型,比较CT、B超对不同类型肝囊型包虫病的诊断符合率。结果400例疑似肝囊型包虫病患者经手术、血清学检查,358例患者确诊为肝囊型包虫病,42例患者确诊为肝泡型包虫病。CT对肝囊型包虫病的诊断灵敏度、特异度、准确率分别为94.13%、83.33%、93.00%,B超对肝囊型包虫病的诊断灵敏度、特异度、准确率分别为98.88%、97.62%、98.75%,B超对肝囊型包虫病的诊断灵敏度、特异度、准确率均高于CT(χ^2=11.978、4.974、16.720,均P<0.05)。经一致性检验,CT、B超对肝囊型包虫病的诊断结果与临床确诊结果之间的一致性系数(Kappa)分别为0.549、0.713,B超与临床确诊结果之间的诊断一致性优于CT。B超对单纯囊肿型、多发囊肿型、子囊孙囊型、囊肿实变型等肝囊型包虫病的诊断符合率均高于CT(χ^2=13.832、6.747、6.331、5.008,均P<0.05),而B超与CT对囊肿钙化型肝囊型包虫病的诊断符合率差异无统计学意义(χ^2=0.213,P>0.05)。结论B超可对肝囊型包虫病予以准确诊断,可作为肝囊型包虫病的首选诊断方法,且B超还可对不同类型肝囊型包虫病予以鉴别。

Objective To study the clinical application value of B-ultrasound in the diagnosis of hepatic cystic hydatid disease. Methods From June 2017 to July 2017, 400 suspected patients with hepatic cystic hydatid disease in the Traditional Chinese Medicine Hospital of Zhoushan were screened in Tibet.All the patients were examined by CT and B-ultrasound.Two CT diagnostics experienced in CT diagnosis and two ultrasound doctors experienced in ultrasound diagnosis were selected to analyze the CT images, B-ultrasound images of the patients, and make the diagnosis.The results of operation or serological examination(clinical diagnosis) were used as the reference.The sensitivity, specificity and accuracy of CT, B-ultrasound in the diagnosis of hepatic cystic hydatid disease were calculated and compared.The consistency between CT, B-ultrasound diagnosis and clinical diagnosis of hepatic cystic hydatid disease was analyzed by consistency test.According to the results of clinical diagnosis, the patients with hepatic cystic hydatid disease were divided into simple cyst type, multiple cyst type, daughter cyst cysts type, cyst calcification type and cyst solid type.The diagnostic coincidence rate of CT, B-ultrasound for different types of hepatic cystic hydatid disease was compared. Results A total of 358 cases were confirmed as hepatic cystic echinococcosis by operation and serological examination, and the remaining 42 cases were confirmed as hepatic bubble echinococcosis.The sensitivity, specificity and accuracy of CT in the diagnosis of liver cystic echinococcosis were 94.13%, 83.33%, 93.00%, respectively, which were lower than those of B-ultrasound (98.88%, 97.62% and 98.75%)(χ^2=11.978, 4.974, 16.720, all P<0.05). According to the consistency test, the consistency coefficient(Kappa) of CT and B-ultrasound in the diagnosis of hepatic cystic echinococcosis was 0.549 and 0.713, respectively, and the diagnostic consistency between B-ultrasound and clinical diagnosis was better than CT.The diagnostic coincidence rates of B-ultrasound for hepatic cystic echinococcosis of simple cyst type, multiple cyst type, descendant cyst type and cyst consolidation type was higher than those of CT(χ^2=13.832, 6.747, 6.331, 5.008, all P<0.05). The diagnostic coincidence rate of B-ultrasound and CT for calcified hepatic cystic echinococcosis had no statistically significant difference (χ^2=0.213, P>0.05). Conclusion B-ultrasound can accurately diagnose hepatic cystic hydatid disease and can be used as the first choice for diagnosis of hepatic cystic hydatid disease, and B-ultrasound can also differentiate different types of hepatic cystic hydatid disease.The diagnostic value is significant.