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中华实验和临床感染病杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 472 -477. doi: 10.3877/cma.j.issn.1674-1358.2019.06.003

所属专题: 专题评论 文献

论著

三维显微定量超声在乙型肝炎肝硬化患者病情评价中的应用
王金环1, 于国英2, 祖红梅3, 杨秀兰4, 郭建英1, 丁瑞花1, 庞玉花1, 杨松5,()   
  1. 1. 810000 南宁市,青海省第四人民医院超声电生理科
    2. 810000 南宁市,青海省第四人民医院肝病二科
    3. 810000 南宁市,青海省第四人民医院消化内科
    4. 810000 南宁市,青海省第四人民医院体检科
    5. 100015 北京,首都医科大学附属北京地坛医院肝病二科
  • 收稿日期:2019-01-11 出版日期:2019-12-15
  • 通信作者: 杨松
  • 基金资助:
    青海省卫生厅医药卫生科研指导性计划课题(No. 2012-11); 艾滋病和病毒性肝炎等重大传染病防治国家科技重大专项(No. 2017ZX10202201,2017ZX10202202); 北京市卫生系统高层次卫生技术人才队伍建设专项经费(No. 2016-108)

Three-dimensional microscopic quantitative ultrasound for evaluating hepatitis B related liver cirrhosis

Jinhuan Wang1, Guoying Yu2, Hongmei Zu3, Xiulan Yang4, Jianying Guo1, Ruihua Ding1, Yuhua Pang1, Song Yang5,()   

  1. 1. Department of Ultrasonography and Electrophysiology, The Fourth People’s Hospital of Qinghai Province, Xining 810000, China
    2. Division 2, Department of Hepatology, The Fourth People’s Hospital of Qinghai Province, Xining 810000, China
    3. Department of Gastroenterology, The Fourth People’s Hospital of Qinghai Province, Xining 810000, China
    5. Division 2, Department of Hepatology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2019-01-11 Published:2019-12-15
  • Corresponding author: Song Yang
  • About author:
    Corresponding author: Yang Song, Email:
引用本文:

王金环, 于国英, 祖红梅, 杨秀兰, 郭建英, 丁瑞花, 庞玉花, 杨松. 三维显微定量超声在乙型肝炎肝硬化患者病情评价中的应用[J/OL]. 中华实验和临床感染病杂志(电子版), 2019, 13(06): 472-477.

Jinhuan Wang, Guoying Yu, Hongmei Zu, Xiulan Yang, Jianying Guo, Ruihua Ding, Yuhua Pang, Song Yang. Three-dimensional microscopic quantitative ultrasound for evaluating hepatitis B related liver cirrhosis[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2019, 13(06): 472-477.

目的

初步评估三维显微定量超声对于乙型肝炎肝硬化及肝功能失代偿的诊断价值。

方法

收集2016年1月至2017年12月青海省第四人民医院住院患者共270例,分为慢性乙型肝炎(CHB)组(102例)、代偿期肝硬化(LC)组(84例)和失代偿期LC组(84例)。入组患者均行三维显微定量超声检查、二维剪切波弹性成像检查及肝功能、血常规等检查。计算患者的天门冬氨酸氨基转移酶和血小板比率指数(APRI)评分。比较3组患者间三维显微定量超声、二维剪切波弹性成像(2D-SWE)和APRI评分差异。评价三维显微定量超声、2D-SWE和APRI评分指标对于LC以及LC相关肝功能失代偿的预测价值、灵敏度和特异度。

结果

3组患者三维显微定量超声和肝脏硬度差异均有统计学意义(F = 313.52、173.36,P均< 0.001)。三维显微定量超声预测LC的受试者操作曲线下面积为0.925(95%CI:0.885~0.965,P < 0.001),取三维显微定量超声临界值为11.5分,其诊断LC的敏感度和特异度分别为85.7%和90.2%;三维显微定量超声预测LC相关肝功能失代偿的受试者操作曲线下面积为0.850(95%CI:0.795~0.905、P < 0.001),取三维显微定量超声临界值为16.5分,其诊断肝功能失代偿的敏感度和特异度分别为60.7%和89.3%。

结论

本研究建立了基于三维显微超声技术的定量诊断标准,该标准可用于LC及失代偿LC的辅助诊断。

Objective

To evaluate the diagnosis value of 3D microscopic ultrasound sonography for hepatitis B related liver cirrhosis (LC) and liver function decompensation.

Methods

Total of 270 patients were admitted to the Fourth People’s Hospital of Qinghai Province from January 2016 to December 2017, which were divided into chronic hepatitis B group (102 cases), compensatory LC group (84 cases) and decompensation LC group (84 cases). 3D microscopic ultrasound sonography, 2D shear waved elastography (2D-SWE) and blood routine examination were performed on each patient. Aspartate aminotransferase-to-platelet ratio index (APRI) were calculated. 3D microscopic ultrasound sonography scores, 2D-SWE scores and APRI were compared among the three groups, respectively. Receptor operation curves were built to compare the predictive values of 3D microscopic ultrasound sonography scores, 2D-SWE scores and APRI for LC and for liver function decompensation of LC patients.

Results

The score of 3D microscopic ultrasound sonography and liver hardness among the three groups were significantly different (F = 313.52, 173.36; both P < 0.001). The area under receptor operation curve (AUROC) of 3D microscopic ultrasound sonography for predicting cirrhosis was 0.925 (95%CI: 0.885-0.965, P < 0.001); with the cut-off value of 11.5 scores, the sensitivity and specificity of 3D microscopic ultrasound sonography for predicting cirrhosis were 85.7% and 90.2%, respectively. The AUROC of 3D microscopic ultrasound sonography for predicting decompensated cirrhosis was 0.850 (95%CI: 0.795-0.905, P < 0.001). With the cut-off value of 16.5 scores, the sensitivity and specificity of 3D microscopic ultrasound sonography for predicting decompensated cirrhosis were 60.7% and 89.3%, respectively.

Conclusions

A quantitative diagnostic standard based on 3D microscopic ultrasound sonography was established in this study, which could be used in the auxiliary diagnosis of LC and liver function decompensation.

表1 肝脏三维显微超声肝纤维化定量评分表
表2 三组患者的一般资料和肝功能指标
表3 三组患者三维超声评分、肝脏硬度和APRI指数
图1 三维定量超声、2D-SWE和APRI诊断LC受试者操作曲线
图2 三维定量超声、2D-SWE和APRI诊断失代偿期LC的受试者操作曲线
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