南方医科大学学报 ›› 2006, Vol. 26 ›› Issue (08): 1200-.

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超声波评分系统评估病毒性肝炎相关性肝纤维化

李小玲; 陈永鹏; 戴琳; 朱幼芙; 罗小克; 侯金林;   

  1. 解放军313医院传染科; 南方医科大学南方医院感染内科; 南方医科大学南方医院感染内科 辽宁葫芦岛125000; 广东广州510515; 辽宁葫芦岛125000;
  • 出版日期:2006-08-20 发布日期:2006-08-20

An ultrasonographic scoring system for screening compensated liver cirrhosis in patients with chronic hepatitis B and C virus infection

LI Xiao-ling1, CHEN Yong-peng2, DAI Lin2, ZHU You-fu2, LUO Xiao-ke1, HOU Jin-lin2 1Department of Infectious Disease, No 313 Hospital of PLA, Huludao 125000, China; 2Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China   

  1. 解放军313医院传染科; 南方医科大学南方医院感染内科; 南方医科大学南方医院感染内科 辽宁葫芦岛125000; 广东广州510515; 辽宁葫芦岛125000;
  • Online:2006-08-20 Published:2006-08-20

摘要: 目的了解肝、胆、脾超声波检查指标与肝脏纤维化程度的相关性,探讨代偿性肝炎后肝硬化超声波筛检诊断组合。方法统计248例慢性肝炎病人超声波检查资料及肝组织病理学诊断,进行回顾性统计学分析。结果肝组织纤维化状态与肝包膜光滑度、门静脉内径无相关性;不同肝组织纤维化状态的肝实质回声均匀度、血管走行、胆囊壁状态及脾大程度有统计学差别;上述4个指标正常时,其肝硬化阴性预告值高达96.3%,评分≥5可筛检出90%代偿性肝硬化,7诊断代偿性肝硬化的准确率85.9%、特异性度高达95.2%,但灵敏度低至37.5%。结论代偿性肝硬化超声波肝实质回声、血管走行、胆囊壁状态及脾大等指标与其他肝纤维化状态有显著差别,其评分系统可作为慢性肝炎病人筛检代偿性肝硬化的灵敏诊断系统。 

Abstract: Objective To investigate the correlation between the stage of hepatic fibrosis and ultrasonographic findings of the liver, spleen and gallbladder and establish a sensitive ultrasonographic semi-quantitative scoring system for screening compensated liver cirrhosis. Methods Totalling 248 patients with chronic hepatitis B and hepatitis C virus infection underwent liver biopsy and ultrasonic examination. The images of the liver surface, parenchymal echo, intrahepatic vessels, gallbladder, spleen and diameter of portal vein were analyzed. Results The stages of hepatic fibrosis were not correlated to ultrasonographic findings of the liver surface or diameter of portal vein, but hepatic fibrosis of different stages showed significant differences in parenchymal echo, intrahepatic vessels, gallbladder and splenomegaly. In cases with normal liver parenchymal, intrahepatic vessels, gallbladder and spleen, the negative predictive value of the ultrasonographic semi-quantitative scoring system for diagnosing compensated liver cirrhosis amounted to 96.3%. The sensitivity of a score not lower than 5 was 90% for detecting compensated cirrhosis. With a score not lower than 7, the diagnostic accuracy and specificity was 85.9% and 95.2%, respectively, but the sensitivity was lowered to 37.5%. Conclusion The ultrasonic images of the liver parenchyma, intrahepatic vessels, gallbladder and spleen in patients with compensated liver cirrhosis vary significanly in patients with hepatic fibrosis of different stages, and this ultrasonographic scoring system allows for a sensitive diagnosis of compensated cirrhosis. 

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