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目的找出区别于肝纤维化(S0-3)及早期肝硬化(S4)的超声学指标,建立一个无创诊断早期肝硬化的模型,并评估模型的诊断效果。方法选取肝穿刺活检确诊的慢性乙型肝炎(CHB)患者99例,其中男性79例,女性20例;年龄18～61岁,平均年龄41.83岁。均行超声检查。收集的指标包括反映肝、脾的大小和血流动力学的指标,患者的年龄和性别,找出有意义的指标,建立一个诊断模型。统计分析的方法包括单因素分析、logistic多因素分析及接受者操作特征(ROC)曲线等。结果脾脏的厚径和脾动脉收缩期峰速/舒张期末流速之比(S/D)2个指标最后经筛选进入了模型,该数学模型诊断早期肝硬化(S4)指数(ECI)=logit P(y=肝硬化)=-14.965+1.401×脾脏厚径+2.883×脾动脉S/D,选取合适的阈值,灵敏度和特异度分别为100.00%和78.10%。结论超声学指标的数学模型对早期肝硬化的诊断有一定的临床价值,但尚需进一步验证。
OBJECTIVE To find out the ultrasonic indexes different from those of liver fibrosis (S0-3) and early cirrhosis (S4), to establish a non-invasive model of early cirrhosis and to evaluate the diagnostic value of the model. Methods 99 cases of chronic hepatitis B (CHB) diagnosed by liver biopsy were selected. There were 79 males and 20 females, aged from 18 to 61 years, with an average age of 41.83 years. All underwent ultrasound examination. The indicators collected included indicators of liver and spleen size and hemodynamics, the age and gender of the patient, the identification of meaningful indicators, and the establishment of a diagnostic model. Methods of statistical analysis include univariate analysis, logistic multivariate analysis, and receiver operating characteristic (ROC) curves. Results Two indexes (S / D), including the thickness of the spleen and the ratio of the peak systolic / diastolic velocity of the splenic artery, were finally screened and entered into the model. The mathematical model of early diagnosis of cirrhosis (S4) index (logit P (y = cirrhosis) = -14.965 + 1.401 × spleen thickness + 2.883 × splenic artery S / D, the appropriate threshold value was selected and the sensitivity and specificity were 100.00% and 78.10%, respectively. Conclusion The mathematical model of the ultrasonic index has certain clinical value in the diagnosis of early liver cirrhosis, but further verification is needed.