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目的 探索超声二维图像和多普勒血流显像对慢性病毒性肝炎患者中纤维化程度和早期肝硬化的诊断价值。 方法 324例慢性病毒性肝炎患者根据肝穿刺活检组织学结果分为无肝纤维化(S0)到肝硬化(S4)五期。活检组织按炎症分级为G1~G4四级。比较各组间超声指标的差异。 结果 在超声定性指标中,肝表而回声,肝实质光点形态和分布异常等指标都与肝纤维化分期和炎症分级有相关性。但这些定性指标对具体患者的诊断判断变异很大。在不同纤维化程度分组间,脾长径,脾门静脉内径在各组间差异有统计学意义。根据脾长径界限值12.1 cm,诊断早期肝硬化的敏感度为60.0％,特异性为75.3％;脾静脉内径以8 mm作为界限值,诊断早期肝硬化的敏感度为60.0％,特异性为78.1％;门静脉主干内径12 mm,诊断早期肝硬化的敏感度76.7％,特异性44.6％。门静脉最大流速界限值为30.5 cm／s时,诊断早期肝硬化的敏感度为78.6％,特异性为66.9％。 结论 超声检查是诊断早期肝硬化的有效工具,是临床实用的方法,并适用于随访复查。
Objective To explore the value of two-dimensional ultrasound imaging and Doppler flow imaging in the diagnosis of fibrosis and early cirrhosis in patients with chronic viral hepatitis. Methods A total of 324 patients with chronic viral hepatitis were divided into five stages of liver fibrosis (S0) and cirrhosis (S4) according to the results of liver biopsy. Biopsy grading by inflammation grade G1 ~ G4 four. Compare the differences of ultrasound indexes between the groups. Results Ultrasound qualitative indicators, liver surface and echo, liver parenchyma spot patterns and abnormal distribution and other indicators and liver fibrosis staging and inflammation grade correlation. However, these qualitative indicators of the diagnosis of specific patients vary widely. In different degree of fibrosis group, spleen length, diameter of splenic portal vein in each group differences were statistically significant. The sensitivity and specificity of diagnosing early cirrhosis were 60.0% and 75.3%, respectively, based on the long axis diameter of 12.1 cm. The sensitivity of diagnosing early cirrhosis was 8.0% with a splenic vein diameter of 8 mm. The specificity was 78.1%. The main diameter of portal vein was 12 mm. The sensitivity and specificity of diagnosing early cirrhosis was 76.7% and 44.6% respectively. When the portal vein maximum flow velocity limit was 30.5 cm / s, the sensitivity of diagnosis of early cirrhosis was 78.6% and the specificity was 66.9%. Conclusion Ultrasonography is an effective tool to diagnose early cirrhosis, is a clinical and practical method, and is suitable for follow-up review.