慢性丙型肝炎患者肝脏回声增强模式的患病率：与脂肪变性和纤维化的相关性。

The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis.

作者信息

Loy Maurizio, Serra Giancarlo, Chessa Luchino

机构信息

Ultrasonography Unit, CDR, Via Zagabria 60, 09129 Cagliari, Italy.

Liver Unit, Department of Medical Sciences, Policlinico Universitario, University of Cagliari, SS 554 Bivio Sestu, 09042 Monserrato, Cagliari Italy.

出版信息

J Ultrasound. 2014 Jul 5;19(2):91-8. doi: 10.1007/s40477-014-0114-5. eCollection 2016.

DOI:10.1007/s40477-014-0114-5

PMID:27298639

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4879006/

Abstract

PURPOSE

To evaluate the prevalence of bright liver echo pattern (BLP) on ultrasonography and its correlation with liver steatosis (LS), and fibrosis in patients with chronic hepatitis C. The usefulness of detecting skip areas for steatosis diagnosis has also been evaluated.

METHODS

The study included 88 patients with chronic hepatitis C (55 men, 33 women, average age 45.7 ± 11.2 years). Ultrasound examination was performed in all patients before liver biopsy. The presence of BLP was assessed and graded from 1 to 3. Hypoechogenic areas (skip areas) around the gallbladder or near the portal vein were also evaluated. Hepatic fibrosis was assessed using the Ishak fibrosis score. Steatosis was graded as follows: 1, 2, 3 (<30, 30-70, >70 % of hepatocytes affected, respectively).

RESULTS

Fifty-three of the 88 patients (60 %) showed BLP (40 grade 1, 13 grades 2 or 3). Skip areas were found in 14 patients (16 %). Histological steatosis was observed in 40 patients (45 %) and in 10 of them (25 %) was grades 2 and 3 (4 and 6 patients, respectively). As regards fibrosis, 2 patients showed F0, 34 F1, 28 F2, 20 F3, 4 F4, none of them F5 and F6. BLP of grades 2 or 3 and presence of skip areas were strongly correlated with LS (P = 0.00007 and P = 0.00003, respectively). No correlation was found between BLP and fibrosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of BLP for LS were 75, 50, 56, 68 and 61 %, respectively. When BLP of grades 2 and 3 and LS of 30 % or more were correlated, the sensitivity, specificity, PPV, NPV and accuracy of BLP were 72, 96, 61, 96 and 90 %, respectively. As regards skip areas the sensitivity, specificity, PPV, NPV and accuracy for LS were 35, 100, 100, 64 and 70 %, respectively.

CONCLUSIONS

In a well-defined group of patients with chronic hepatitis C, the detection of BLP grades 2 and 3 has a good sensitivity and high specificity for high grades of steatosis. A high specificity but low sensitivity for liver steatosis was also found for skip areas, whereas mild fibrosis does not seem to correlate with the hyperechogenicity of the liver.

摘要

目的

评估慢性丙型肝炎患者肝脏超声检查中明亮肝回声模式（BLP）的发生率及其与肝脂肪变性（LS）和纤维化的相关性。同时评估检测脂肪变性诊断中的跳跃区域的实用性。

方法

该研究纳入了88例慢性丙型肝炎患者（55例男性，33例女性，平均年龄45.7±11.2岁）。所有患者在肝活检前均进行了超声检查。评估BLP的存在并将其从1到3级进行分级。还评估了胆囊周围或门静脉附近的低回声区域（跳跃区域）。使用Ishak纤维化评分评估肝纤维化。脂肪变性分级如下：1、2、3级（分别为<30%、30 - 70%、>70%的肝细胞受累）。

结果

88例患者中有53例（60%）表现出BLP（40例为1级，13例为2级或3级）。14例患者（16%）发现有跳跃区域。40例患者（45%）观察到组织学脂肪变性，其中10例（25%）为2级和3级（分别为4例和6例）。关于纤维化，2例患者为F0，34例为F1，28例为F2，20例为F3，4例为F4，无F5和F6级。2级或3级BLP以及跳跃区域的存在与LS密切相关（P分别为0.00007和0.00003）。未发现BLP与纤维化之间存在相关性。BLP对LS的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为75%、50%、56%、68%和61%。当2级和3级BLP与30%或更高的LS相关时，BLP的敏感性、特异性、PPV、NPV和准确性分别为72%、96%、61%、96%和90%。关于跳跃区域，对LS的敏感性、特异性、PPV、NPV和准确性分别为35%、100%、100%、64%和70%。