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目的与传统Child-Turcotte-Pugh(CTP)评分及晚近终末期肝病的危险度评分模型(modelforend-stageliverdisease,MELD)评分比较,探讨无创定量超声评分评估肝纤维化程度的可能性。方法对53例肝纤维化患者及25例健康对照者进行经皮肝穿刺活体组织病理检查、超声检查及各项临床指标检查,以病理诊断结果为标准,计算CTP及MELD评分,并参考相关文献建立无创定量超声评分标准,探讨超声评分对肝纤维化无创定量诊断的价值。结果肝纤维化患者超声评分与病理学肝纤维化分期相关性良好,超声总评分与病理分期相关系数为0.860(P<0.01);超声总评分与临床CTP及MELD评分相关性良好,相关系数为0.784及0.768(P<0.01);超声、CTP、MELD评分3种方法结合使用,诊断肝纤维化的敏感性96.7%,特异性95.5%。结论应用超声评分法无创诊断肝纤维化有较高的临床价值。
Objective To compare the predictive value of Child-Turcotte-Pugh (CTP) score and MELD score in predicting the degree of hepatic fibrosis by noninvasive quantitative ultrasound. Methods Percutaneous transhepatic liver biopsy was performed in 53 patients with liver fibrosis and 25 healthy controls. The pathological examination, ultrasonography and various clinical indexes were performed. The CTP and MELD scores were calculated based on the pathological findings, and the relative literatures The establishment of non-invasive quantitative ultrasound scoring criteria to explore the ultrasonic score of non-invasive quantitative diagnosis of liver fibrosis value. Results The correlation between the ultrasound score and the pathological stage of liver fibrosis was good. The correlation coefficient between total ultrasound and pathological staging was 0.860 (P <0.01). The total score of ultrasound was correlated well with clinical CTP and MELD scores, and the correlation coefficient was 0.784 and 0.768 respectively (P <0.01). The combination of ultrasound, CTP and MELD scored 96.7% and specificity of 95.5% for the diagnosis of liver fibrosis. Conclusion Noninvasive diagnosis of liver fibrosis with ultrasound scoring has higher clinical value.