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目的探讨超声背向散射积分(IBS)技术在肝纤维化及早期肝硬化诊断中的应用价值。方法应用HP5500彩色多普勒超声诊断仪检测42例正常人及114例慢性乙型病毒性肝炎患者(无肝纤维化40例、肝纤维化36例、早期肝硬化38例)肝实质近场、中场、远场的IBS值,结合病理结果进行对比分析。结果各组肝脏近、中、远场的IBS值比较:肝纤维化组及早期肝硬化组肝脏近场、中场、远场的IBS值较正常对照组增加,组间两两比较差异有统计学意义(P<0.05),肝炎组、肝纤维化组、早期肝硬化组中肝脏近场、中场、远场的IBS值均表现为依次增高,组间两两比较,差异有统计学意义(P<0.05)。同一组内不同区域IBS值比较:对照组、肝炎组各组内肝脏近场、中场、远场IBS值比较依次降低,两两比较差异有统计学意义(P<0.05);肝纤维化组、早期肝硬化组肝脏中场IBS值高于近场及远场,且二组内近场IBS值高于远场,两两比较差异有统计学意义(P<0.05);通过ROC曲线分析,肝脏近、中、远场IBS值分别为29.71,35.82,25.16dB时,诊断肝纤维化的敏感度分别为86.7%、97.2%、97.2%;特异度分别为66.7%、68.3%、68.3%;肝脏近、中、远场IBS值分别为34.85、38.04、31.32dB时,诊断肝硬化的敏感度分别为97.4%、97.4%、92.1%,特异度分别为85.6%、81.4%、85.6%;肝脏近、中、远场IBS与肝纤维化分期的相关系数分别为:0.889、0.916、0.911,差异有统计学意义(P<0.01)。结论 IBS技术能反映出肝实质纤维化的病理改变,同时能做出量化分析,为临床提供一种无创诊断肝纤维化的检查方法。
Objective To investigate the value of ultrasonic backscatter integration (IBS) in the diagnosis of liver fibrosis and early liver cirrhosis. Methods Forty-two healthy subjects and 114 patients with chronic hepatitis B (40 cases without liver fibrosis, 36 cases with liver fibrosis and 38 cases with early liver cirrhosis) were detected by HP5500 color Doppler sonography in near-field, Midfield, far field IBS values, combined with pathological results for comparative analysis. Results Comparison of IBS values in the proximal, middle and far-field liver of each group: IBS values in liver, mid-field and far-field in liver fibrosis group and early liver cirrhosis group were higher than those in normal control group (P <0.05). The IBS values in the liver, liver fibrosis and early liver cirrhosis groups in the near field, midfield and far field of liver cirrhosis group were all significantly higher than those in the liver cirrhosis group (P <0.05), and the difference was statistically significant (P <0.05). IBS values in different regions within the same group were compared: the IBS value of liver near field, midfield and far field in the control group and hepatitis group were successively decreased compared with each other, the difference was statistically significant (P <0.05); liver fibrosis group The IBS values in the liver of the early cirrhosis group were higher than those in the near and far fields, and the IBS values in the two groups were higher than those in the far field. There was significant difference between the two groups (P <0.05). By ROC curve analysis, The sensitivities of hepatic fibrosis were 86.7%, 97.2% and 97.2% when the IBS values were 29.71, 35.82 and 25.16 dB in the proximal, middle and far fields, respectively; the specificity were 66.7%, 68.3% and 68.3% respectively; The sensitivities of hepatic cirrhosis were 97.4%, 97.4%, 92.1%, and specificity of 85.6%, 81.4%, 85.6% respectively when the IBS values of liver near, far and far were 34.85, 38.04 and 31.32 dB respectively. The correlation coefficients of IBS and liver fibrosis staging were 0.889, 0.916, 0.911 respectively, with significant difference (P <0.01). Conclusion IBS can reflect the pathological changes of hepatic parenchymal fibrosis, meanwhile make quantitative analysis and provide a noninvasive diagnosis method for liver fibrosis in clinic.