彩色多普勒超声半定量评分对早期乙型肝炎肝硬化的诊断价值

doi:10.3969/j.issn.1672-5069.2017.01.020

摘要/Abstract

摘要： 目的研究彩色多普勒超声半定量评分诊断早期乙型肝炎肝硬化的临床价值。方法选择2014年8月~2015年12月在我院诊治的肝硬化患者136例和慢性乙型肝炎患者364例,使用GE Logiq E8彩色多普勒超声诊断仪检测肝脏超声并进行半定量评分,常规进行肝活检。结果肝硬化组门静脉流量、流速和内径分别为（86.3±7.5） ml/min、（3.8±0.1） cm/s、（11.5±1.4） mm,均明显高于慢性乙型肝炎组[分别为（62.3±6.4） ml/min、（3.1±0.1） cm/s、（8.7±1.6） mm,P<0.05];慢性乙型肝炎组肝静脉清晰度、肝表面被膜、胆囊壁、肝脏边缘形态、肝脏实质回声、肝内韧带、脾脏面积评分和总分分别为（1.1±0.3）分、（1.2±0.3）分、（1.1±0.2）分、（1.0±0.4）分、（1.1±0.5）分、（1.0±0.2）分、（1.4±0.4）分、（8.12±0.39）分,均明显低于肝硬化组[分别为（2.6±0.3）分、（4.1±1.2）分、（1.9±0.3）分、（1.9±1.0）分、（2.7±0.4）分、（1.4±0.5）分、（4.1±1.6）分、（15.1±1.1）分,P<0.05];彩色多普勒超声半定量评分对早期乙型肝炎肝硬化的诊断灵敏度为96.3%,特异度为92.31%,阳性预测值为82.4%,阴性预测值为98.5%。结论彩色多普勒超声半定量评分对早期乙型肝炎肝硬化的诊断具有较高的灵敏度和特异度,可作为临床筛检早期乙型肝炎肝硬化的有效方法。

关键词: 肝硬化, 慢性乙型肝炎, 彩色多普勒超声, 半定量评分

Abstract: Objective To investigate the diagnostic value of color Doppler ultrasound semi-quantitative score in the diagnosis of patients with viral hepatitis B liver cirrhosis. Methods 136 patients with hepatitis B liver cirrhosis and 364 with hepatitis B were recruited between August 2014 and December 2015 in this study. The portal vein flows,flow rates and internal diameters and semi-quantitative scores were conducted for the diagnostic validity of color Doppler ultrasound. Results The portal venous flow,velocity and diameter in cirrhotic group were （86.3±7.5） ml/min,（3.8±0.1） cm/s,（11.5±1.4） mm,significantly higher than those in patients with hepatitis B [（62.3±6.4） ml/min,（3.1±0.1） cm/s,（8.7±1.6） mm,P<0.05];the distinct of hepatic vein,hepatic surface,gallbladder,liver morphological edge,liver parenchyma,intrahepatic ligament,and the size of spleen and the total scores in patients with hepatitis B were （1.1±0.3）,（1.2±0.3）,（1.1±0.2）,（1.0±0.4）,（1.1±0.5）,（1.0±0.2）,（1.4±0.4）,（8.1±0.3）,significantly lower than in cirrhotic group [（2.6±0.3）,（4.1±1.2）,（1.9±0.3）,（1.9±1.0）,（2.7±0.4）,（1.4±0.5）,（4.1±1.6）,（15.1±1.1）,P<0.05];the sensitivity by color Doppler ultrasonic semi quantitative score in diagnosis of early hepatitis B liver cirrhosis was 96.3%,the specificity was 92.3%,the positive predictive value was 82.4%,and the negative predictive value was 98.5%. Conclusion Color Doppler ultrasound semi-quantitative score has high specificity and sensitivity in the diagnosis of early hepatitis B liver cirrhosis, which might be used as an effective method for clinical screening in patients with chronic hepatitis B.

Key words: Liver cirrhosis, Hepatitis B, Color Doppler ultrasound, Semi-quantitative score

魏华, 马旭艳. 彩色多普勒超声半定量评分对早期乙型肝炎肝硬化的诊断价值[J]. 实用肝脏病杂志, 2017, 20(1): 78-80.

Wei Hua, Ma Xuyan.. Diagnostic value of color Doppler ultrasound semi-quantitative scores in the diagnosis of patients with hepatitis B liver cirrhosis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(1): 78-80.

参考文献

[1] 刘文娜, 郝婷婷, 王剑,等. 64层螺旋CT门静脉造影对肝硬化患者肝功能分级和食管静脉曲张破裂出血的预测价值. 实用肝脏病杂志, 2014,17（3):283-286.
[2] 刘宁, 徐杰, 刘金花,等. 慢性乙型肝炎、乙肝肝硬化、乙肝肝癌患者Th1/Th2型细胞因子水平变化研究. 胃肠病学和肝病学杂志, 2014, 23（2):158-161.
[3] Simpson KE, Esmaeeli A, Khanna G, et al. Liver cirrhosis in Fontan patients does not affect one year post-heart transplant mortality or markers of liver function. J Heart Lung Transplant,2014,33（2）:170-177.
[4] 郑美芳. 彩色多普勒超声对老年肝硬化患者门静脉和脾静脉血流动力学检测及临床意义. 中国中西医结合消化杂志,2015,23（6）:404-407.
[5] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南（2015年版）. 实用肝脏病杂志,2016,19（3）：Ⅴ-ⅩⅩⅢ.
[6] 孟繁坤,郑颖,丁蕾,等. 高频超声检查与病理肝纤维化分期相关性的半定量研究. 中国超声医学杂志,2007,23（11）:846-848.
[7] 沈洪,苏子敏,仓静,等. 七氟醚、异氟醚或丙泊酚全身麻醉复合硬膜外阻滞对肝脏切除术后肝肾功能的影响. 临床麻醉学杂志,2007,23（8）:624-626.
[8] 胡珊珊,孙克伟,张茜茜,等. 慢性乙肝病毒感染不同免疫状态患者树突状细胞体外刺激后介导的 T淋巴细胞功能影响的研究. 中国中西医结合杂志,2014,34（4）:418-422.
[9] Sohn HR,Bo YM,Song JC,et al. Off-treatment virologic relapse and outcomes of re-treatment in chronic hepatitis B patients who achieved complete viral suppression with oral nucleostide analogs. Bmc Infect Dis,2014,14（1）:1-8.
[10] Leung NWY,Herrmann E,Lau GKK,et al. Early viral kinetics with telbivudine,tenofovir or combination of both in immunotolerant patients with hepatitis B antigen-positive chronic hepatitis B. Infect Dis Ther,2014,3（2）:1-12.
[11] Seo YS,Kim MY,Kim SU,et al. Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis:A multicentre, retrospective study. Liver Int,2015,35（5）:71-94.
[12] 崔芳芳,龚作炯. 慢性丙型肝炎、肝硬化、肝癌患者血清IL-17、IL-6和维生素D水平变化及其临床意义. 胃肠病学和肝病学杂志,2014,23（12）:1448-1450.
[13] 顾锡炳,朱银芳,王娟华,等. 乙型肝炎肝硬化患者病毒基因型与滤泡辅助性T淋巴细胞及白细胞介素-21的关系和意义. 中华实验和临床病毒学杂志,2014,28（5）：56-58.
[14] 柴能明, 郑平燕. 双歧杆菌三联活菌肠溶胶囊对慢性乙型肝炎后肝硬化患者肝功能及血清细胞因子水平的影响. 中国微生态学杂志,2014,26（8）:910-913.
[15] Grφnbk H,Rφdgaardhansen S,Aagaard NK,et al. The soluble macrophage activation markers sCD163 and mannose receptor （sMR） predict mortality in patients with liver cirrhosis without or with acute-on-chronic liver failure（ACLF）. J Hepatol, 2015,64（4）:813-822.
[16] 谈振华,李江涛,谢平,等. 术后门静脉血栓高危的肝硬化门静脉高压症患者血浆中内皮素-1、降钙素基因相关肽与肝功能的相关性. 中国老年学杂志,2014,6（11）:512-513.
[17] 梅琪, 虞梅, 张菁,等. ARFI技术与血清铁、铁蛋白和肝纤维化四项检测在肝纤维化及肝硬化诊断中的相关性. 东南国防医药, 2014,5（3）:241-243.
[18] 常向云,郑勇,孙侃. B超导向下经皮经肝门静脉穿刺测压法及其对肝硬化患者门静脉压力的测定. 临床内科杂志,2005,22（2）:91-92.