肝脏血流动力学变化对肝纤维化分期诊断价值

The diagnostic value of hepatic hemodynamic changes in staging liver fibrosis

目的探讨肝脏血流动力学软件在肝纤维化分期中的应用价值。方法选取2017年1月—2021年10月于石家庄市第五医院就诊行彩色多普勒检查肝脏检查并行肝组织穿刺活检的慢性乙型肝炎患者148例。应用彩色多普勒超声检测门静脉、肝左静脉、肝中静脉及肝右静脉频谱波形,M型超声测量心率。将频谱图像及心率上传至杭州精康科技有限责任公司生产的肝脏血流动力检测软件系统内,计算出肝纤维化值,与肝组织穿刺活检病理诊断对照。结果148例患者肝组织活检病理诊断0期32例,1期39例,2期24例,3期12例,4期41例。根据肝血流动力学软件诊断值,将148例患者分为4组,其ROC曲线下面积分别为AUC=0.91(95%可信区间0.867~0.959)、0.962(95%可信区间0.938~0.987)、0.975(95%可信区间0.956~0.994)、0.966(95%可信区间0.940~0.993)。根据约登指数最大原则,肝血流动力学软件诊断≥S1、S2、S3、S4期的截断值分别为1.27、3.78、3.98、5.85。肝脏血流动力学软件在评估有无严重纤维化、肝硬化时评估准确性较高,各期AUC均大于0.9,其中S3>S4>S2>S1期。结论肝脏血流动力学软件作为一种新型的无创检测肝纤维化方法,与肝纤维化分期病理改变具有良好的相关性,可较准确地评估肝脏纤维化程度,可在临床推广使用。

Objective To explore the application value of“Liver Hemodynamics Software”in diagnosing liver fibrosis stages.Methods The spectrum waveforms of portal vein,left hepatic vein,middle hepatic vein and right hepatic vein were detected by color Doppler ultrasound,and the heart rates were measured by M-mode ultrasound.The spectrum images and heart rates were uploaded to the“Liver Hemodynamics Software”system produced by Hangzhou Jingkang Technology.The liver fibrosis values were then calculated,and further compared with the pathological diagnosis of Percutaneous Liver Biopsies.Results Among 148 patients,32 cases were diagnosed as stage 0,39 cases as stage 1,24 cases as stage 2,12 cases as stage 3 and 41 cases as stage 4.According to the diagnostic values of Liver Hemodynamics Software,148 patients were divided into four groups,and the area under the receiver operating characteristic curve(AUC)of each group was AUC=0.91(95%confidence interval 0.867~0.959),0.962(95%confidence interval 0.938~0.987),0.975(95%confidence interval 0.956~0.994),and 0.966(95%confidence interval 0.940~0.993),respectively.According to the principle of maximum Jordan index,the cutoff values of staging liver fibrosis for≥S1,S2,S3 and S4 by liver hemodynamics software were 1.27,3.78,3.98 and 5.85,respectively.The Liver Hemodynamics Software showed a high accuracy in assessing whether there had severe fibrosis and cirrhosis.The AUC of each phase was greater than 0.9,of which S3>S4>S2>S1.Conclusion As a new non-invasive method for detecting liver fibrosis,the liver fibrosis values obtained by Liver Hemodynamics Software has a good correlation with the pathological stagings of liver fibrosis,thus may accurately evaluate the degrees of liver fibrosis,and can be widely used in clinical practice.