序贯联合超声指数改善瞬时弹性成像诊断代偿性乙肝肝硬化  

Stepwise combination with ultrasonic index improving performance of transient elastography detecting compensated chronic hepatitis B cirrhosis

作　　者：戴琳[1] 尹军花[1] 冯筱榕[1] 卢燕薇[1] 张琪[1] 梁携儿[1] 朱幼芙[1] 陈永鹏[1] 

机构地区：[1]南方医科大学南方医院感染内科,广州510515

出　　处：《中华超声影像学杂志》2014年第1期40-43,共4页Chinese Journal of Ultrasonography

基　　金：国家“十二五”科技重大专项课题（2013ZX10002004）

摘　　要：目的探讨超声指数诊断代偿期乙肝肝硬化有效性及序贯联合应用超声指数改善瞬时弹性成像（TE）技术对代偿期乙肝肝硬化的诊断效能。方法回顾性分析222例肝活检代偿性慢性乙型肝炎患者资料，记录患者血液常规、血生化指标、凝血功能指标、超声检查肝胆脾及TE检查结果，并进行统计学分析，评价诊断效能。结果肝硬化及非肝硬化患者年龄、胆红素、凝血功能国际标准化比率、血小板、肝硬度值及超声指数差异均有统计学意义，对肝硬化均有诊断效能，以TE、超声指数诊断效能最高[r^oc曲线下面积0．896（0．855—0．937）对0．852（0．793—0．911），Z=1．30，／9=0．19363，两者差异无统计学意义；TE可使65．8％患者确定有或无肝硬化而免于肝活检，明显高于超声指数（41．9％）；序贯联合TE及超声指数可使78．0％明确肝硬化状态的患者免于肝活检。结论由肝胆脾超声指标及年龄构成的超声指数可有效诊断或排除代偿期乙肝肝硬化，同时可作为补充诊断方法提高TE的诊断效能。Objective To investigate the validity of ultrasonic index （USI） in detecting compensated hepatitis B cirrhosis and the improvement of detecting cirrhosis by stepwise combination of transient elastography （TE） and USI. Methods Total of 222 patients with compensated hepatitis 13 undergone liver biopsies were retrospectively investigated. Patients~ hematology, serum biochemical index, coagulation index,TE and ultrasonography of liver, gallbladder and spleen were statistically analyzed to evaluate the diagnostic efficiency. Results There were statistical differences between patients with and without cirrhosis in age, serum bilirubin, international normalized ratio, platelet, liver stiffness and USI, which could efficiently detect cirrhosis. Among them,TE and USI discriminated cirrhosis with higher area under ROCs without statistical difference [0. 896（0. 855 - 0. 937） vs 0. 852（0. 793 - 0. 911）, Z = 1.30, P = 0. 1936]. While TE classified 65.8% of patients as cirrhosis or non-cirrhosis and freed them from liver biopsies, this number decreased to 41.9% in USI, stepwise combination of TE and USI improved this number up to 78.0~. Conclusions USI consisting of age and ultrasonography of liver, gallbladder and spleen was validated to detect cirrhosis with satisfactory efficiency, and could be applied as supplementary non-invasive method to improve performance of TE detecting compensated hepatitis B cirrhosis.

关 键 词：超声检查 乙型肝炎 慢性 肝硬化 瞬时弹性成像 

分 类 号：R575.2[医药卫生—消化系统]