慢性乙型肝炎超声检查与肝活检纤维化分期的对比研究  

Comparison between ultrasonic examination and histopathological staging of liver biopsy specimens in the patients with chronic hepatitis B

作　　者：乐晓华[1] 李汉英[1] 李美忠[1] 王敏[1] 李丽雄[1] 何为芬[1] 

机构地区：[1]深圳市东湖医院病理科,广东省深圳518020

出　　处：《中国基层医药》2007年第2期212-213,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的了解慢性乙型肝炎超声检查结果与肝活检纤维化分期的异同以提高超声检查肝纤维化程度的准确率。方法对185例慢性乙型肝炎患者肝脾进行超声检查，肝活检组织进行纤维化分期（S1～S4）。结果肝脏超声检查与肝纤维化分期呈正相关（r=0．54，P〈0．01）。两者符合率为42．7％（79／185）。超声检查在S1、S2、S3和S4期灵敏度分别为66．7％（22／33）、52．5％（31／59）、27．6％（16／58）和28．6％（10／35），S1、S2期灵敏度高于S3、S4期灵敏度（P〈0．05）。S2期特异度较低、误诊率较高（P〈0．01）。S3、S4期漏诊率高于S1、S2期漏诊率（P〈0．05）。在肝纤维化分期中，超声诊断偏低与诊断偏高的病例数比值为1．9（70／36）。脾脏厚度、门静脉主干内径在纤维化分期与超声诊断较轻的两个组与较重的两个组间的差异有统计学意义（P〈0．05），而肝右斜径在较轻的两个组间的差异有统计学意义（P〈0．05）。结论慢性乙型肝炎患者超声检查能部分反映肝纤维化分期，结合肝右斜径、脾脏厚度、门静脉主干内径的大小和超声诊断分期偏低的现象有助于提高超声检查的准确率。Objective To investigate the differences between ultrasonic examination and histopathological staging of liver biopsy specimens in the patients with chronic hepatitis B to improve the accuracy of ultrasonic diagnosis of liver fibrosis. Methods 185 patients with chronic hepatitis B were undertaken ultrasonic examination of type B and histopathological staging as S1 -S4 of the liver biopsies. Results Positive correlation between ultrasonic examination and histopathological staging was observed（ r = 0.54, P （ 0.01 ）, and 79 of 185 cases were coincident. The diagnostic sensitivities of ultrasonic examination for S1, S2, S3 and S4 were 66.67 % （ 22/33 ）, 52.54 % （31 / 59）, 27.59 % （16/58） and 28.57 % （10/35）, respectively, The sensitivities in S1 and S2 were higher than in S3 and S4 （ P 〈 0.05 ）. There was lowest specificity and highest misdiagnostic rate in S2 （ P 〈 0.01 ）. The omission diagnostic rates in S3 and S4 were higher than in S1, and S2 （P 〈 0.05）. 1.94 （70/36） was the rate between the number of ultrasonic diagnosis not enough and the number of excessive ultrasonic diagnosis. The widths of the spleen and the main portal vein were significantly different between the two Light groups and the other groups in staging or in ultrasonic diagnosis（ P 〈0.05）, and the obLique diameter of fight Liver was significantly different between the two light groups （P〈 0.05 ）. Conclusion Ultrasonic examination can be used to reflect partly histopathological staging of the patients with chronic hepatitis B, and it＇s accuracy may be improved with combining the widths of the spleen and the main portal vein, the oblique diameter of right liver and the phenomenon of ultrasonic diagnosis not enough.

关 键 词：肝炎 乙型 慢性 超声检查 肝硬化 

分 类 号：R575[医药卫生—消化系统] R51[医药卫生—内科学] R44[医药卫生—临床医学]