超声实时弹性成像联合门静脉血流评估慢性乙肝纤维化的应用研究  

Study on the application of real-time tissue elastography combined with portal vein blood flow in evaluating chronic hepatitis B fibrosis

作　　者：黄岩花[1] 赖小伟[1] 周利芬[1] 陈方红[1] 

机构地区：[1]浙江省丽水市中心医院,浙江丽水323000

出　　处：《中国现代医生》2017年第9期124-127,共4页China Modern Doctor

基　　金：浙江省丽水市科技计划项目(2014ZC009)

摘　　要：目的将超声实时组织弹性成像(real-time tissue elastograph,RTE)与彩色多普勒门静脉血流指标检测联合应用于乙肝患者肝纤维化的评估,分析两者结合对评估肝纤维化的应用价值。方法对150例正常人进行超声实时弹性成像弥散定量分析及门静脉血流检测,计算肝弹性指数(LF Index),确定正常肝脏肝弹性指数(LF Index)及门静脉最大流速的标准,然后应用超声实时组织弹性成像联合门静脉血流检测技术对100例慢性乙型病毒性肝炎患者的肝脏纤维化程度进行定量分析,同时与慢性乙型病毒性肝炎患者肝组织病理学结果对照分析。结果以正常肝脏肝弹性指数及正常门静脉血流最大流速为标准,在100例慢性乙型病毒性肝炎(乙肝)患者中,RTE分析诊断患者肝纤维化灵敏度、特异度分别为92.0%、89.0%,RTE联合门静脉最大流速诊断灵敏度、特异度依次为97.3%、96.0%,且RTE联合门静脉血流评估诊断准确度(92.0%)明显高于单独应用RTE,差异具有统计学意义(P<0.05)。结论弹性指数能判定肝纤维化的有无,并在一定程度上反映肝纤维化的程度。两种方法联合诊断效果优于单一弹性指数评估肝纤维化方法,联合诊断可提高诊断的准确性,从而能有效减少肝穿刺活检,具有重大临床意义。Objective To apply real-time tissue elastography（RTE） combined with color Doppler portal vein blood flow measurement to the evaluation of liver fibrosis in the patients with hepatitis B, and to analyze the application value of the combination of the two in evaluating liver fibrosis. Methods 150 cases of healthy subjects were given RTE quanti- tative analysis and portal vein blood flow measurement, and the liver elastic index （LF Index） was calculated, so as to determine the standard of normal liver elastic index （LF Index） and portal vein maximum flow rate. Afterwards, the degree of hepatic fibrosis in 100 patients with chronic hepatitis B was quantitatively analyzed by RTE combined with portal vein blood flow measurement. At the same time, the results were compared with the liver histopathological results in the patients with chronic hepatitis B. Results The normal hepatic elastic index and the maximum flow rate of normal portal vein were taken as the standard. In 100 patients with chronic hepatitis B virus （hepatitis B）, the sensitivity and specificity of RTE in the analysis and diagnosis of liver fibrosis were 92.0% and 89.0% respectively. The sensitivity and specificity of RTE combined portal vein maximum flow rate were 97.3% and 96.0%, and the diagnostic accuracy of RTE combined with portal vein blood flow （92.0%） was significantly higher than that of RTE alone. The difference was statistically significant （P〈0.05）. Conclusion The elastic index can determine the presence or absence of hepatic fibrosis and, to a certain extent, reflect the degree of hepatic fibrosis. The combined effect of the two methods is superior to the elastic index alone in the evaluation of hepatic fibrosis. The combined diagnosis can improve the accuracy of diagnosis, which can effectively reduce the liver biopsy, and has a great clinical significance.

关 键 词：超声实时弹性成像 门静脉血流 肝纤维化 病理分期 

分 类 号：R575.2[医药卫生—消化系统]