超声测量静脉内径在血吸虫肝硬化及乙型肝炎肝硬化鉴别中的应用

Application of ultrasonic measuring the diameter of vein in differentiating between schistosomiasis cirrhosis and hepatitis B cirrhosis

目的探讨超声测量门静脉、脾静脉和肠膜上静脉内径在血吸虫肝硬化及乙肝肝硬化鉴别中的应用价值。方法选取2019年8月至2021年8月收治的78例肝硬化患者纳入研究对象,其中血吸虫肝硬化33例,乙肝肝硬化45例,另外选取同期于我院体检且身体健康的39名志愿者纳入研究对象。血吸虫肝硬化、乙肝肝硬化患者(治疗前)及健康人入院后均使用西门子Acuson Sequoia 512彩色多普勒超声诊断仪对门静脉主干内径(DPV)、脾静脉内径(DSPV)、肠系膜上静脉内径(DSMV)进行测量。对比血吸虫肝硬化、乙肝肝硬化患者及健康人DPV、DSPV及DSMV水平差异,借助ROC分析DPV诊断血吸虫肝硬化及乙肝肝硬化的价值。结果健康人DPV、DSPV及DSMV水平分别为(10.4±1.8)mm、(7.1±1.1)mm、(6.9±2.4)mm,血吸虫肝硬化患者DPV、DSPV及DSMV水平分别为(11.9±2.6)mm、(9.3±2.2)mm、(10.7±2.0)mm,乙肝肝硬化患者DPV、DSPV及DSMV水平分别为(14.8±3.3)mm、(9.4±2.4)mm、(10.8±2.3)mm;血吸虫肝硬化及乙肝肝硬化患者DPV、DSPV及DSMV水平显著高于健康人,差异有统计学意义(P<0.05);血吸虫肝硬化患者DPV水平显著低于乙肝肝硬化患者,差异有统计学意义(P<0.05)。经ROC分析证实DPV诊断血吸虫肝硬化的曲线下面积为0.734,标准误为0.056,95%CI为0.624~0.845,最佳截断值为10.750,敏感度为0.822,特异度为0.590,P<0.05;经ROC分析证实DPV诊断乙肝肝硬化的曲线下面积为0.825,标准误为0.053,95%CI为0.722~0.928,最佳截断值为12.300,敏感度为0.727,特异度为0.923,P<0.05。结论相对于健康人,血吸虫肝硬化及乙肝肝硬化患者DPV、DSPV及DSMV呈现出明显的增高,且血吸虫肝硬化及乙肝肝硬化患者DPV也存在明显的差异,经ROC分析证实DPV最佳截断值为10.750 mm、12.300 mm时能够为两种疾病的诊断、鉴别提供帮助。

Objective To investigate the application value of venous diameter measured by ultrasound in differentiating between schistosomiasis cirrhosis and hepatitis B cirrhosis.Methods A total of 78 patients with liver cirrhosis admitted to our hospital from August 2019 to August 2021 were included.Thirty-three cases were diagnosed as schistosomiasis cirrhosis and 45 cases were diagnosed as hepatitis B cirrhosis.Another 39 healthy volunteers who underwent physical examination in our hospital during the same period were also selected.Patients with schistosomiasis cirrhosis,patients with hepatitis B liver cirrhosis(before treatment)and healthy controls were all scanned by Siemens Acuson Sequoia 512 color Doppler ultrasound diagnostic apparatus to measure diameter of portal vein(DPV),diameter of splenic vein(DSV),diameter of superior mesenteric vein(DSMV).The DPV,DSPV and DSMV values of patients with schistosomiasis cirrhosis,patients with hepatitis B cirrhosis and healthy controls were compared.The value of DPV in diagnosing schistosomiasis cirrhosis and hepatitis B cirrhosis were analyzed by receiver operator characteristic(ROC)curve.Results The values of DPV,DSPV and DSMV in healthy controls were(10.4±1.8)mm,(7.1±1.1)mm,(6.9±2.4)mm,respectively.The values of DPV,DSPV and DSMV in patients with schistosomiasis cirrhosis were(11.9±2.6)mm,(9.3±2.2)mm,(10.7±2.0)mm,respectively.The values of DPV,DSPV and DSMV in patients with hepatitis B cirrhosis were(14.8±3.3)mm,(9.4±2.4)mm,(10.8±2.3)mm,respectively.The values of DPV,DSPV and DSMV of patients with schistosomiasis cirrhosis and patients with hepatitis B cirrhosis were significantly higher than those of healthy people(P<0.05).The DPV value of patients with schistosomiasis cirrhosis was significantly lower than that of patients with hepatitis B cirrhosis(P<0.05).ROC analysis showed that the area under the curve(AUC)of DPV in diagnosing schistosomiasis cirrhosis was 0.734,the standard error was 0.056,the 95%IC was 0.624 to 0.845,the best cutoff value was 10.750,the sensitivity was 0.822,the specificity was 0.590(P<0.05).ROC analysis showed that the AUC of DPV in diagnosing hepatitis B cirrhosis was 0.825,the standard error was 0.053,the 95%IC was 0.722~0.928,the best cut-off value was 12.300,the sensitivity was 0.727,and the specificity was 0.923(P<0.05).Conclusion Compared with healthy people,the DPV,DSPV and DSMV values of patients with schistosome cirrhosis and patients with hepatitis B cirrhosis are significantly higher.The DPV value between patients with schistosome cirrhosis and patients with hepatitis B cirrhosis is significantly different.ROC analysis confirmed that DPV can help diagnosing and differentiating the 2 diseases when the best cutoff values are 10.750 mm and 12.300 mm.