Shen Lei, Li Ji-Qiang, Zeng Min-de, Fan Si-Tao, Lu Lun-Gen, Bao Hai, Cao Ai-Ping
Department of Gastroenterology, Shanghai Second Medical University, Shanghai Institute of Digestive Diseases, Shanghai 200001, China.
Zhonghua Gan Zang Bing Za Zhi. 2005 Feb;13(2):117-20.
It is important to use noninvasive methods to differentiate liver fibrosis and liver cirrhosis. A prospective study was conducted to evaluate the validity of ultrasonography (US) in evaluating the severity of liver fibrosis in patients with chronic viral hepatitis in reference to the pathologic diagnosis of their liver biopsy specimens.
The liver fibrosis status of 324 chronic viral hepatitis patients was evaluated by both needle biopsy and US. Histologically their liver fibrosis was graded as S0-S4, and the inflammatory reaction in the liver was graded as G1-G4. The US examination included qualitative description of the liver surface and liver parenchyma, and the quantitative parameters were vascular diameters, blood flow volume and spleen size.
US qualitative description of the liver surface and liver parenchyma was correlated to the severity of fibrosis and the degree of the inflammation seen in the liver biopsies. An analysis of US quantitative parameters showed that a cut-off value of 12.1 cm for the length of spleen had a sensitivity of 60.0%, and specificity of 75.3% in detecting early liver fibrosis. For other quantitative parameters, the cut-off values were 8mm for the diameter of the splenic vein, 30.5 cm/sec for maximal blood flow velocity in the portal vein and 12 mm in diameter of the main portal vein. The diagnostic sensitivities for these parameters were 60.0%, 78.6% and 76.7%; the diagnostic specificities were 78.1%, 66.9% and 44.6% respectively.
Early cirrhosis can be detected by US, and the sonographic results were well paralleled with their pathologic diagnoses made by liver biopsies. Individual US parameter has limited sensitivity and specificity in diagnosing early cirrhosis. In clinical practice a combination of 2-3 parameters could be used to detect or exclude severe liver fibrosis.
运用非侵入性方法鉴别肝纤维化和肝硬化至关重要。开展一项前瞻性研究，参照慢性病毒性肝炎患者肝活检标本的病理诊断，评估超声检查（US）在评估此类患者肝纤维化严重程度方面的有效性。
对324例慢性病毒性肝炎患者的肝纤维化状况进行针吸活检和超声检查评估。从组织学上，其肝纤维化分为S0 - S4级，肝脏炎症反应分为G1 - G4级。超声检查包括肝脏表面和肝实质的定性描述，定量参数有血管直径、血流量和脾脏大小。
超声对肝脏表面和肝实质的定性描述与肝活检中所见纤维化严重程度及炎症程度相关。超声定量参数分析显示，脾脏长度截断值为12.1 cm时，检测早期肝纤维化的敏感度为60.0%，特异度为75.3%。对于其他定量参数，脾静脉直径截断值为8mm，门静脉最大血流速度截断值为30.5 cm/秒，门静脉主干直径截断值为12 mm。这些参数的诊断敏感度分别为60.0%、78.6%和76.7%；诊断特异度分别为78.1%、66.9%和44.6%。
超声可检测出早期肝硬化，超声检查结果与肝活检病理诊断结果高度相符。单个超声参数在诊断早期肝硬化时敏感度和特异度有限。在临床实践中，可联合2 - 3个参数来检测或排除严重肝纤维化。
