肝静脉波形分型联合肝脏超声半定量评分对慢性乙型肝炎患者肝纤维化程度评估价值研究*

doi:10.3969/j.issn.1672-5069.2022.02.009

摘要/Abstract

摘要： 目的旨在探讨应用肝静脉波形分型联合超声肝脏半定量评分对慢性乙型肝炎(CHB)患者肝纤维化分期的评估价值。方法 2018年2月～2020年12月我院收治的126例CHB患者,均行肝活检和超声检查,行超声半定量评分和肝静脉波形分型,应用MedCal 15.2软件绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评价肝静脉波形分型联合肝脏超声半定量评分评估CHB患者肝纤维化程度的效能。结果在126例CHB患者中,组织病理学诊断肝纤维化S0期20例,S1期28例,S2期31例,S3期22例和S4期25例;S0期、S1期、S2期、S3期和S4期患者超声半定量评分分别为(3.1±0.5)分、(5.4±0.9)分、(6.7±1.1)分、(8.3±1.5)分和(9.9±1.8)分,组间差异显著(P<0.05);S3期和S4期患者肝静脉HVⅠ型/HV Ⅱ型占比分别为40.9%和56.0%,均显著高于S0期、S1期和S2期者(分别为5.0%,10.7%,16.1%,P<0.05);采用静脉波形分型、超声半定量评分和两者联合诊断CHB患者显著肝纤维化分期的AUC分别为0.846(95%CI为0.753～0.938)、0.827(95%CI为0.729～0.924)和0.919(95%CI为0.853～0.985),两者联合诊断的效能显著高于静脉波形分型或超声半定量评分单独诊断(P＜0.05),其灵敏度和特异度分别为85.1%和97.5%,显著高于肝静脉波形(分别为87.2%和83.5%)或超声评分(分别为85.1%和86.1%)诊断。结论采用肝静脉波形分型联合超声肝脏半定量评分评估CHB患者显著肝纤维化有一定的应用价值,可为临床诊断提供一种影像学方法,值得临床进一步研究和验证。

关键词: 慢性乙型肝炎, 肝纤维化, 肝静脉波形分型, 超声半定量评分, 诊断

Abstract: Objective The aim of this study was to explore the evaluation of significant liver fibrosis by hepatic vein waveform classification and ultrasound-based semi-quantitative scoring in patients with chronic hepatitis B(CHB). Methods 126 patients with CHB were admitted to our hospital between February 2018 and December 2020, and all patients with CHB underwent liver biopsies and were examined by ultrasound. The ultrasound semi-quantitative score of liver and the hepatic vein waveform typing were recorded. The diagnostic efficacy of sonographic parameters in predicting significant liver fibrosis (>=S2) was evaluated by the area under the receiver operating characteristic curve (AUC) by MedCal 15.2 software. Results The histopathological examination showed S0 in 20, S1 in 28, S2 in 31, S3 in 22 and S4 in 25 cases; the ultrasound semi-quantitative scores in patients with S0, S1, S2, S3, and S4 were(3.1±0.5), (5.4±0.9), (6.7±1.1), (8.3±1.5) and (9.9±1.8), significantly different among them(P<0.05); the percentages of HV type I and HV type II in patients with S3 and S4 were 40.9% and 56.0%, both significantly higher than 5.0%, 10.7%, 16.1% (P<0.05) in patients with S0, S1 and S2; the AUCs of hepatic venous waveform, ultrasound semi-quantitative scoring and the combination of the two in predicting significant liver fibrosis were 0.846(95%CI:0.753-0.938), 0.827(95%CI:0.729-0.924) and 0.919(95%CI:0.853-0.985), suggesting the combination of the two parameters was superior to any one of the parameter alone(P＜0.05), and its sensitivity and specificity were 85.1% and 97.5%, significantly higher than 87.2% and 83.5% by hepatic venous waveform or 85.1% and 86.1% by ultrasound semi-quantitative scoring. Conclusion The combination of hepatic vein waveform classification and ultrasonographic semi-quantitative scoring is efficacious in assessing the liver fibrosis staging in patients with CHB, which might provide an alternative imaging tool in clinical practice.

Key words: Hepatitis B, Liver fibrosis, Hepatic vein waveform classification, Ultrasound semi-quantitative score, Diagnostic trial

黄平, 曾霞, 张亚萍, 毛加丽. 肝静脉波形分型联合肝脏超声半定量评分对慢性乙型肝炎患者肝纤维化程度评估价值研究^*[J]. 实用肝脏病杂志, 2022, 25(2): 187-190.

Huang Ping, Zeng Xia, Zhang Yaping, et al. Evaluation of significant liver fibrosis by hepatic vein waveform classification and ultrasound-based semi-quantitative scoring in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2022, 25(2): 187-190.

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肝静脉波形分型联合肝脏超声半定量评分对慢性乙型肝炎患者肝纤维化程度评估价值研究^*

Evaluation of significant liver fibrosis by hepatic vein waveform classification and ultrasound-based semi-quantitative scoring in patients with chronic hepatitis B

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