彩色多普勒超声半定量评分在乙肝肝纤维化诊断的应用价值

Application value of semiquantitative score of color Doppler ultrasound in the diagnosis of hepatitis B liver fibrosis

目的探讨彩色多普勒超声半定量评分在乙肝肝纤维化诊断中的应用价值。方法采用GE-LOGIQ9彩色超声诊断仪检查227例接受肝穿刺活检的慢性乙肝肝纤维化患者,进行肝被膜、光点分布、肝实质回声、边缘形态、肝静脉清晰度、肝内韧带、脾及脾静脉、胆囊壁等半定量评分,并收集经皮肝穿刺活检结果。分析半定量评分与炎症分级、肝纤维化分级和肝纤维化血清学指标的相关性。结果不同炎症分级和肝纤维化分级患者半定量评分总分差异均有统计学意义(P<0.05)。炎症分级G3级患者半定量评分总分高于G1、G2级(P<0.05)。不同炎症分级患者肝被膜、光点分布、肝实质回声、边缘形态和胆囊壁评分差异有统计学意义(P<0.05)。肝纤维化分级S3级患者半定量评分总分高于S0、S1、S2级(P<0.05)。不同肝纤维化分级患者肝被膜、光点分布、肝实质回声、边缘形态、肝静脉清晰度、肝内韧带、脾及脾静脉和胆囊壁评分差异均有统计学意义(P<0.05)。乙肝肝纤维化患者半定量评分总分与炎症分级、肝纤维化分级、透明质酸、Ⅳ型胶原和层粘连蛋白均呈正相关(r=0.372、0.431、0.604、0.375、0.551,P<0.05)。结论彩色多普勒超声半定量评分对慢性乙肝肝纤维化的炎症反应及肝纤维化严重程度具有较高的诊断价值,且与血清学指标亦有较好的相关性。

Objective To explore the application value of semiquantitative score of color Doppler ultrasound in the diagnosis of hepatitis B liver fibrosis.Methods A total of 227 patients with chronic hepatitis B liver fibrosis underwent liver biopsy were enrolled.The semiquantitative score of the liver capsule,light spot distribution,liver parenchyma echo,marginal morphology,hepatic vein clarity,intrahepatic ligament,spleen and splenic vein,and gallbladder wall was performed using GE-LOGIQ9 color ultrasound diagnostic instrument.The percutaneous liver biopsy results were collected.The correlations between semiquantitative scores and inflammation grade,liver fibrosis grade and serum index of liver fibrosis were analyzed.Results There were significant differences in the total semiquantitative scores of the patients with different inflammation grades and liver fibrosis grades(P<0.05).The total semiquantitative score of the patients with inflammation grade G3 was higher than that of the patients with inflammation grade G1 and G2(P<0.05).There were significant differences in the scores of liver capsule,light spot distribution,echo of liver parenchyma,marginal morphology and gallbladder wall among patients with different inflammation grades(P<0.05).The total semiquantitative score of the patients with liver fibrosis grade S3 was higher than that of the patients with liver fibrosis grade S0,S1,S2(P<0.05).There were significant differences in the scores of liver capsule,light spot distribution,echo of liver parenchyma,marginal morphology,hepatic vein clarity,intrahepatic ligament,spleen and splenic vein,and gallbladder wall among the patients with different fibrosis grades(P<0.05).The total semiquantitative score of hepatitis B patients with hepatic fibrosis was positively correlated with inflammatory grade,hepatic fibrosis grade,hyaluronic acid,typeⅣcollagen and laminin(r=0.372,0.431,0.604,0.375,0.551,P<0.05).Conclusion The semiquantitative score of color Doppler ultrasound has a higher diagnostic value for the inflammatory reaction of chronic hepatitis B liver fibrosis and the severity of liver fibrosis,which has a good correlation with serological indicators.