超声定量诊断慢性乙型肝炎肝纤维化的临床价值探讨  

Evaluation on the value of ultrasonic quantitative method in diagnosing liver fibrosis in chronic hepatitis B patients

作　　者：陈明丽[1] 王怡[1] 杨永明[1] 蔡叶华[1] 周国辉[2] 

机构地区：[1]复旦大学附属华山医院超声医学科,上海200040 [2]复旦大学电子工程系

出　　处：《中华传染病杂志》2011年第2期94-98,共5页Chinese Journal of Infectious Diseases

基　　金：基金项目：上海市科学技术委员会科研计划项目（064119524）

摘　　要：目的探讨超声定量诊断慢性乙型肝炎（CHB）肝纤维化的l临床价值。方法采集186例有肝活组织病理检查结果的CHB患者的超声标准声像图，观测肝包膜厚度，并提取声像图纹理的14个灰度共生矩阵参数，与肝纤维化病理诊断进行比较。各定量指标在纤维化病理分期问的差异及与其相关性分别采用方差分析和Spearman相关分析，由定量指标分别建立对纤维化分期和分组的判别分析模型。结果14个灰度共生矩阵参数和肝包膜厚度共15个指标中，仅方差（F=0．55，y=0．06；均P〉0．05）、均值和（F=0．61，r=0．05；均P〉0．05）、和熵（F=1．68，r=0．09；均P≥O．05）及熵（F=1．39，r=0．12，P〉O．05）在病理分期间的差异无统计学意义且与其不相关。交互检验表明，建立的判别分析模型对肝纤维化按so至s4分期正确率分别为80．0％、64．9％、61．3％、74．1％和80．6％，73．1％的病例能被准确分期，诊断不同程度纤维化的敏感度、特异度、准确度，≥s1为97．6％、80．0％、91．9％，≥s2为92．1％、89．7％、90．9％，≥s3为94．8％、96．1％、95．7％，s4为80．6％、97．4％、94．6％。按so无纤维化、s1轻度纤维化、s2和s3中重度纤维化、s4早期肝硬化分组，正确率分别为8l_7％、78．4％、56．9％和90．3％，74．7％的病例能被准确分组，诊断不同程度纤维化的敏感度、特异度、准确度，≥轻度纤维化为97．6％、81．7％、92．5％，≥中重度纤维化为83．1％、94．8％、89．2％，早期肝硬化为90．3％、93．5％、93．0％。结论无创的超声检查结合声像图纹理分析对定量诊断CHB肝纤维化具有一定参考价值。Objective To evaluate the value of ultrasonic quantitative method in the diagnosis of liver fibrosis in chronic hepatitis B （CHB） patients. Methods Ultrasonography was performed in 186 CHB patients who underwent liver biopsies. Fifteen indices including liver capsule thickness and fourteen texture parameters of gray level co-occurrence matrix were extracted from standard sonograms and compared with fibrosis stages by histopathology. The status of liver fibrosis was divided into five stages from SO to S4 by histopathology based on the disease severity. ANOVA and Spearman correlation analysis were applied to analyze the differences and relationships between these indices and pathological stage, respectively. Theri discriminant analysis models were established based on the indices for quantitative diagnosis of liver fibrosis. Results Among the fifteen indices, including liver capsule thickness, only the variance （F=0.55, r=0.06% both P〉0.05）, sum average （F= 0.6l, both r=0.05; PD0.05）, sum entropy （F=1. 68, r=0.09; both P〉0.05） and entropy （F=1.39,r=0. 12; both P）0.05） were not significantly associated with the stages and not manifested linear correlation. Using biopsy results as gold standard, the correct rank rate of discriminant analysis model analysis in the patients staged from SO to s4 were 80. 0%, 64. 9%, 61.3% , 74. 1% and 80.6 %, respectively. There were 73.1 % of cross-validated cases who were accurately classified by the model analysis. The sensitivity, speeificity and accuracy in patien＇ts with stage ≥ were 97. 6%, 80.0% and 91.9% , respectively; those in pAtients with stage≥2 were 92. 1%, 89.7% and 90.9%, respectively; those in patients with stage%3 were 94.80/00, 96.1% and 95.7%; and those in patients with stage 4 were 80.6%, 97.4% and 94.69%, respeetively. When considered SO as no fibrosis, S1 as mild fibrosis, $2 and $3 as moderate to severe fibrosis and S4 as early cirrhosis, the consistence rates between diseriminant analysis model and biopsy result were 81.7%, 78.4%

关 键 词：肝炎 乙型 慢性 肝硬化 超声检查 矩阵 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575.2[医药卫生—诊断学]