【摘要】：目的：探討多普勒超聲判斷彌漫性肝病病變程度的應用價值。 方法：回顧性分析2010年~2013年于山西醫(yī)科大學第一附屬醫(yī)院感染科就診，經超聲引導下肝穿刺活檢確診的112例彌漫性肝病患者的多普勒超聲檢查資料，按臨床及病理穿刺結果所得疾病種類分別針對每一種彌漫性肝病的超聲特點進行總結性分析，其中慢性乙型肝炎按肝實質回聲分為彌漫性改變組、彌漫性不均勻性改變組、彌漫性網格狀改變組、彌漫性網格狀伴結節(jié)形成組，與10例健康志愿者作為對照組進行組間比較，比較的指標有肝右葉最大斜徑、門靜脈內徑及其流速、肝動脈峰值流速、阻力指數、脾臟大�。ㄆ⑴K厚徑、脾臟長徑、脾臟解剖長徑）；藥物性肝病的分析方法同上；非酒精性脂肪性肝炎分為輕度彌漫性改變組、中度彌漫性改變組、重度彌漫性改變組，與10例健康志愿者作為對照組進行組間比較，比較指標同上；而自身免疫性肝炎、原發(fā)性硬化性膽管炎、原發(fā)性膽汁性肝硬化、Gilbert綜合癥這4種疾病均不進行分組，分別將其與10例健康志愿者作為對照組進行比較，比較指標同上，同時還重點觀察肝內、肝外膽管走行；管壁回聲；膽囊壁回聲等。 結果： 1.慢性乙型肝炎（41例） ①彌漫性改變組11例，彌漫性不均勻性改變組14例，彌漫性網格狀改變組9例，彌漫性網格狀伴結節(jié)形成組7例。 ②彌漫性網格狀伴結節(jié)形成組的肝動脈峰值流速（71.47±4.87cm/s）、阻力指數（0.73±0.04）、脾臟解剖長徑（14.64±2.17cm）均與其它四組存在統(tǒng)計學差異；而其門靜脈內徑（1.25±0.16cm）、門靜脈流速（16.20±2.65cm/s）、脾臟厚徑(4.49±0.52cm)同對照組、彌漫性改變組、彌漫性不均勻性改變組間存在統(tǒng)計學差異；彌漫性網格狀改變組的門靜脈內徑（1.20±0.08cm）同對照組、彌漫性改變組存在差異，門靜脈流速（17.16±2.78cm/s）和肝動脈峰值流速（65.42±4.21cm/s）同對照組存在差異，脾臟解剖長徑（13.84±1.06cm）同對照組、彌漫性改變組、彌漫性不均勻性改變組間存在統(tǒng)計學差異；彌漫性網格狀伴結節(jié)形成組和彌漫網格狀組的肝右葉最大斜徑均同對照組有差異。 ③彌漫網格狀伴結節(jié)形成組中有2例可見脾臟肋下及邊。 2.藥物性肝�。�37例） ①彌漫性改變組6例，彌漫性不均勻性改變組7例，彌漫性網格狀改變組13例，彌漫性網格狀伴結節(jié)形成組11例 ②彌漫性網格伴結節(jié)形成組門靜脈內徑（1.29±0.11cm）、門靜脈流速（16.36±2.31cm/s）、肝動脈峰值流速（72.87±5.17cm/s）、阻力指數（0.73±0.06）、脾臟的長徑（12.64±1.03cm）、解剖長徑（14.20±2.56cm）均同其它四組存在統(tǒng)計學差異；彌漫網格狀改變組門靜脈內徑（1.21±0.09cm）、阻力指數（0.67±0.02）、脾臟的長徑（12.01±0.91cm）、解剖長徑（13.56±1.89cm）均同對照組和彌漫性改變組存在差異，而肝動脈峰值流指數（66.11±5.31cm/s）僅同對照組有差異。 ③彌漫網格狀組中有2例可見脾臟肋下及邊；彌漫網格狀伴結節(jié)形成組中為3例。 ④3例病理結果為肉芽腫性病變的在超聲上的表現均為彌漫不均勻性改變，另有2例病理結果顯示為重度肝細胞及毛細膽管性淤膽，其聲像圖上可見肝實質回聲呈彌漫性改變，肝內管壁回聲增強，膽囊呈重度炎性改變。3.非酒精性脂肪性肝炎（14例） ①輕度彌漫性改變組7例，中度彌漫性改變組5例，重度彌漫性改變組2例。②重度彌漫性改變組其門靜脈內徑（1.23±0.12cm）與正常對照組、輕度彌漫性改變組比較均有顯著的差異；而門脈血流速度（16.87±2.14cm/s）與其它三組無統(tǒng)計學差異；肝動脈峰值流速（70.47±2.65cm/s）和阻力指數（0.74±0.03）均與其它三組存在統(tǒng)計學差異，而脾臟解剖長徑（12.37±0.61cm）同對照組有統(tǒng)計差異。中度彌漫性改變組的門靜脈內徑（1.18±0.11cm）同對照組存在差異，肝動脈峰值流速（65.32±3.43cm/s）同對照組和輕度彌漫性改變組存在差異。 4.自身免疫性肝炎（11例）9例肝實質回聲較低，增粗，欠均勻，2例為彌漫性改變；3例肝內管壁回聲增強；7例膽囊壁增厚，2例膽囊腔縮小，2例為膽囊實體樣改變；肝門淋巴結腫大3例；9例脾臟增大（3個徑線均同對照組有差異），7例肝大（肝右葉最大斜徑14.39±1.56與對照組有差異）；CDFI示肝內血流無特殊變化。 5.原發(fā)性硬化性膽管炎（5例）3例肝內散在的片狀強回聲；3例膽總管壁呈不均勻性增厚（厚約0.34—0.45cm）致管腔不規(guī)則狹窄，呈僵硬的高回聲帶，狹窄上段膽管擴張不明顯；1例肝外膽管壁回聲增強伴管壁增厚，3例肝內膽管壁回聲增強；2例可見肝內三級膽管局限性擴張；5例均出現膽囊壁毛糙并不均勻性增厚，約0.28—0.38cm，伴膽結石1例；2例肝大，3例脾大（厚徑和解剖長徑同對照有統(tǒng)計學差異）；未見肝門淋巴結增大；肝動脈峰值流速（72.57±3.21cm/s）、阻力指數（0.71±0.06）均增高，相比較對照組有差異，門脈流速（18.07±1.26cm/s）與對照組比較有差異，門靜脈內徑（1.06±0.22cm）與對照組無差異。 6.原發(fā)性膽汁性肝硬化（1例）肝右葉最大斜徑14.21cm，，提示肝臟增大；肝實質回聲呈略增粗或細密樣稍強回聲改變；肝內血管走形相對正常；膽囊壁毛糙；脾臟3個徑線為10.4cmX4.1cm X13.8cm提示脾大；門靜脈內徑1.28cm；CDFI示門靜脈血流速度為16.21cm/s，肝動脈峰值流速78.23cm/s、阻力指數0.78。 7.Gilbert綜合癥（3例）1例肝實質回聲略增強呈彌漫性改變，2例為肝內回聲增粗欠均勻；肝右葉最大斜徑無統(tǒng)計學差異，3例脾臟均大（長徑及解剖長徑同對照組有差異），CDFI示肝內血流無特殊變化。 結論： 1.通過對彌漫性肝病患者的超聲檢查發(fā)現：肝實質回聲，膽道系統(tǒng)，門靜脈內徑及其流速，肝動脈峰值流速及阻力指數，脾臟的大小，均可很大程度上反映肝臟病變的嚴重程度及發(fā)展趨勢。 2.在非肝炎病毒所致肝損傷中藥物性肝病所占的比例較大（本文占52.11%），超聲提示肝臟有損傷時，在除外病毒性肝炎后多應想到有藥物性肝病的可能。 3.自身免異性肝病早期的臨床診斷有一定困難,本文通過對11例自身免疫性肝炎、5例原發(fā)性硬化性膽管炎、1例原發(fā)性膽汁性肝硬化的病例分析得出，在超聲檢查中應注意以下幾點： ①對于有肝臟增大同時病毒學檢查指標陰性者，應考慮自身免疫性肝炎的可能； ②對于膽汁郁積者,多觀察膽管壁是否增厚以及管腔狹窄的嚴重程度，不要將管壁增厚變窄的膽管、狹窄上段的膽管輕度擴張視為正常的膽管，提高原發(fā)性硬化性膽管炎的診斷率； ③對于肝硬化門脈高壓的患者，通過觀查肝臟的形態(tài)和回聲及血流情況，以注意有無原發(fā)性膽汁性肝硬化的存在。
[Abstract]:Objective: To explore the diagnostic value of Doppler ultrasound in diffuse liver disease.
Methods: The data of Doppler ultrasonography in 112 patients with diffuse liver disease diagnosed by ultrasound-guided liver biopsy in the Department of Infection, the First Affiliated Hospital of Shanxi Medical University from 2010 to 2013 were retrospectively analyzed. Summary analysis showed that chronic hepatitis B patients were divided into diffuse change group, diffuse inhomogeneous change group, diffuse reticular change group, diffuse reticular change group, diffuse reticular with nodule formation group, and 10 healthy volunteers as control group. The index of comparison was the maximum oblique diameter of right lobe of liver, the diameter of portal vein and its diameter. Flow velocity, peak hepatic artery flow velocity, resistance index, spleen size (spleen thickness, spleen length, spleen anatomical length); analysis methods for drug-induced liver disease were the same; non-alcoholic steatohepatitis was divided into mild diffuse change group, moderate diffuse change group, severe diffuse change group, and 10 healthy volunteers as control group. Compared with 10 healthy volunteers as control group, autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis and Gilbert syndrome were not divided into four groups. Echo; gallbladder wall echo.
Result:
1. chronic hepatitis B (41 cases)
(1) There were 11 cases in diffuse change group, 14 cases in diffuse inhomogeneous change group, 9 cases in diffuse grid change group and 7 cases in diffuse grid with nodule formation group.
(2) The peak hepatic artery velocity (71.47 There was significant difference between the two groups in diffuse inhomogeneous changes, and in the diffuse reticular changes, the internal diameter of portal vein (1.20 + 0.08cm) was different from that of the control group, the portal vein velocity (17.16 + 2.78 cm / s) and the peak hepatic artery velocity (65.42 + 4.21 cm / s) were different from those of the control group, and the anatomical length of spleen (13.84 + 1.06c). M) There was significant difference between diffuse change group and control group, diffuse change group, diffuse inhomogeneous change group, diffuse reticular nodule formation group and diffuse reticular group, and the maximum oblique diameter of right lobe of liver was different from control group.
3. In the diffuse grid with nodule formation, 2 cases showed the spleen under the ribs and edges.
2. drug-induced liver disease (37 cases)
(1) There were 6 cases in diffuse change group, 7 cases in diffuse inhomogeneous change group, 13 cases in diffuse grid change group, and 11 cases in diffuse grid with nodule formation group.
(2) The internal diameter of portal vein, portal vein velocity, hepatic artery peak velocity, resistance index, spleen length and anatomical diameter of diffuse reticular nodule formation group were significantly different from those of the other four groups. Diameter (1.21 [0.09cm], resistance index (0.67 [0.02]), spleen length (12.01 [0.91 cm], anatomical length (13.56 [1.89cm]) were significantly different from the control group and diffuse change group, but the peak flow index (66.11 [5.31 cm / s] of hepatic artery was only different from the control group.
(3) Subcostal and marginal spleens were seen in 2 cases of diffuse reticulation group and 3 cases of diffuse reticulation with nodule formation group.
(4) The ultrasonographic manifestations of 3 cases with granulomatous lesions were diffuse and heterogeneous, and 2 cases with severe hepatocytic and capillary cholestasis showed diffuse changes in the echo of liver parenchyma, enhanced echo of intrahepatic duct wall and severe inflammation of gallbladder. Hepatitis (14 cases)
There were 7 cases in mild diffuse change group, 5 cases in moderate diffuse change group and 2 cases in severe diffuse change group. Peak arterial flow velocity (70.47 (+2.65 cm/s) and resistance index (0.74 (+0.03)) were significantly different from those of the other three groups, while splenic anatomical length (12.37 (+0.61 cm) was statistically different from that of the control group. There were differences between mild diffuse group and mild diffuse group.
4. 9 cases of autoimmune hepatitis (11 cases) had low echo of hepatic parenchyma, thickening and inhomogeneous, 2 cases had diffuse changes; 3 cases had enhanced echo of intrahepatic duct wall; 7 cases had thickened gallbladder wall, 2 cases had narrowed gallbladder cavity, 2 cases had solid changes of gallbladder; 3 cases had enlarged hilar lymph nodes; 9 cases had enlarged spleen (3 diameters were different from the control group); 7 cases had enlarged liver (right hepatic duct). The maximum oblique diameter of the lobe was 14.39 + 1.56, which was different from that of the control group. CDFI showed no special changes in blood flow in the liver.
5. Three cases of primary sclerosing cholangitis (5 cases) had scattered sheet echoes in the liver; three cases had irregular stenosis of the common bile duct wall (about 0.34-0.45 cm thick), stiff hyperechoic cords, and no obvious dilatation of the upper bile duct; one case had enhanced echoes of the extrahepatic bile duct wall with thickening of the duct wall; three cases had enhanced echoes of the intrahepatic bile duct wall; Limited dilatation of the third-grade intrahepatic bile duct was seen in 1 case, roughness and uneven thickening of the gallbladder wall in 5 cases, about 0.28-0.38 cm, with gallstones in 1 case, hepatomegaly in 2 cases, splenomegaly in 3 cases (thickness and anatomical diameter were the same as the control group), no enlargement of hilar lymph nodes, peak velocity of hepatic artery (72.57 + 3.21 cm/s) and resistance index (0.71 + 0.06). Compared with the control group, the portal vein velocity (18.07 + 1.26 cm/s) was different, and the internal diameter of portal vein (1.06 + 0.22 cm) was not different.
6. Primary biliary cirrhosis (1 case), the largest oblique diameter of the right lobe of the liver was 14.21 cm, suggesting enlargement of the liver; slightly enlarged or dense echoes of the liver parenchyma; relatively normal blood vessels in the liver; rough gallbladder wall; splenomegaly with 3 diameter lines of 10.4 cm X 4.1 cm X 13.8 cm; portal vein internal diameter of 1.28 cm; portal vein blood flow velocity with CDFI The degree was 16.21cm/s, the peak velocity of hepatic artery was 78.23cm/s, and the resistance index 0.78..
7. In Gilbert syndrome (3 cases), 1 case showed diffuse enhancement of hepatic parenchyma echo, 2 cases showed inhomogeneous enhancement of intrahepatic echo, the largest oblique diameter of the right lobe of the liver had no statistical difference, 3 cases had large spleen (the length and anatomical diameter were different from those of the control group), and CDFI showed no special changes of intrahepatic blood flow.
Conclusion:
1. Ultrasound examination of diffuse hepatopathy showed that echo of liver parenchyma, biliary system, diameter and velocity of portal vein, peak velocity and resistance index of hepatic artery, and size of spleen could reflect the severity and development trend of hepatopathy to a great extent.
2. Drug-induced liver disease accounts for a large proportion of non-hepatitis virus-induced liver injury (52.11%). When ultrasound indicates liver injury, the possibility of drug-induced liver disease should be considered after excluding viral hepatitis.
3. The early clinical diagnosis of autoimmune heterosexual liver disease is difficult. Through the analysis of 11 cases of autoimmune hepatitis, 5 cases of primary sclerosing cholangitis and 1 case of primary biliary cirrhosis, the following points should be paid attention to in ultrasonic examination:
(1) The possibility of autoimmune hepatitis should be considered in patients with liver enlargement and negative viral markers.
(2) For patients with cholestasis, more attention should be paid to the thickening of bile duct wall and the severity of lumen stenosis, not to the thickening and narrowing of bile duct wall, slight dilatation of the upper bile duct as normal bile duct, so as to improve the diagnosis rate of primary sclerosing cholangitis.
(3) For patients with cirrhosis and portal hypertension, the morphology, echo and blood flow of the liver were observed to observe the presence or absence of primary biliary cirrhosis.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R575

【相似文獻】

相關期刊論文 前10條

1 莊風弟;雙重對比檢查結腸克隆氏病的彌漫性粘膜顆粒[J];臨床放射學雜志;1982年02期

2 彭偉;伴氣流阻塞的彌漫性肺纖維化的臨床實況和分類[J];國際呼吸雜志;1984年04期

3 胡藝平,李學楝;急性口底蜂窩織炎并膿腔出血1例[J];陜西醫(yī)學雜志;1992年12期

4 趙浩剛,晏培松,李玉松,王冰峰,朱新生;尼曼—匹克病伴彌漫性系膜增生腎小球腎炎1例[J];臨床與實驗病理學雜志;1992年04期

5 韓維田,姜淼,邊超英,王格,李學付,李偉洲;彌漫性掌跖角化病一家系16例[J];中華皮膚科雜志;2005年05期

6 胡文宗;急性腦外傷對心臟的影響[J];中國實用內科雜志;1983年05期

7 孫樂,曾抗,周再高,刁友濤,王茜;系統(tǒng)性紅斑狼瘡合并彌漫性肺泡出血三例分析[J];中華風濕病學雜志;2005年07期

8 李耀宗;多發(fā)骨淋巴管瘤一例報告[J];臨床放射學雜志;1992年02期

9 劉青云,樸海善;彌漫性軸索損傷[J];山西醫(yī)藥雜志;2001年02期

10 蘇江水,張紅敏,魏世鵬;肺彌漫性纖維化2例[J];罕少疾病雜志;2005年02期

相關會議論文 前10條

1 許建鋒;;彌漫性脈絡膜血管瘤一例的超聲表現[A];中國眼底病論壇·全國眼底病專題學術研討會論文匯編[C];2008年

2 盧桂玲;肖尹;王慶文;;新生兒彌漫性皮膚肥大細胞增生癥1例[A];首屆全國中西醫(yī)結合變態(tài)反應學術會議論文匯編[C];2002年

3 夏汝山;王秋楓;楊維玲;;彌漫性掌跖角皮病1例[A];美麗人生 和諧世界——中華醫(yī)學會第七次全國醫(yī)學美學與美容學術年會、中華醫(yī)學會醫(yī)學美學與美容學分會20周年慶典暨第三屆兩岸四地美容醫(yī)學學術論壇論文匯編[C];2010年

4 喻光懋;崔健;王海勇;周偉軍;趙志芳;;復雜性彌漫性肺大泡癥的電視胸腔鏡外科處理[A];第七屆全國胸腔鏡外科學術會議論文集[C];2004年

5 程文;隋惠珍;荊慧;郭文佳;;高頻超聲對彌漫性甲狀腺乳頭狀癌的診斷價值[A];中國超聲醫(yī)學工程學會第七屆全國腹部超聲學術會議學術論文匯編[C];2007年

6 梁軍;趙品婷;邵秋菊;裴美來;袁燦亮;尹永信;;應用立體定向半肝交替放射治療彌漫性轉移性肝癌[A];2007第六屆全國放射腫瘤學學術年會論文集[C];2007年

7 陳龍;;急性早幼粒細胞白血病合并彌漫性血管內疑血臨床觀察[A];第十一屆全國血栓與止血學術會議暨血栓栓塞性疾�。ㄑㄅc止血）基礎與臨床研究進展學習班論文摘要匯編及學習班講義[C];2007年

8 呂智嫻;李玉娟;張運紅;;彩色多普勒超聲在診斷彌漫性甲狀腺疾病中的應用[A];中國超聲醫(yī)學工程學會第二次全國淺表器官及外周血管超聲醫(yī)學學術會議論文匯編[C];2009年

9 滑炎卿;;彌漫性肺腫瘤的CT診斷與鑒別診斷[A];中華醫(yī)學會第十三屆全國放射學大會論文匯編（上冊）[C];2006年

10 費舟;章翔;何遠東;李志剛;李樹合;梁景文;劉先珍;;彌漫性腦創(chuàng)傷與二次腦損傷發(fā)生機理研究[A];新世紀 新機遇 新挑戰(zhàn)——知識創(chuàng)新和高新技術產業(yè)發(fā)展（上冊）[C];2001年

相關重要報紙文章 前10條

1 劉寧春;彌漫性間質性肺病10%易誤診[N];江蘇科技報;2006年

2 吳靜;別被“彌漫性肝病”嚇著[N];健康時報;2005年

3 付東紅;幽門螺桿菌感染對胃炎類型影響明顯[N];健康報;2007年

4 李忠;腹脹腹痛是何因 心電圖下見分明[N];農村醫(yī)藥報（漢）;2006年

5 張平;哪些病變需做腦電圖[N];農村醫(yī)藥報（漢）;2007年

6 劉淼冰 張麟;鑒別彌漫性泛細支氣管炎[N];健康報;2006年

7 張雪芳;2008年夏季豬流行病的防治[N];中國畜牧獸醫(yī)報;2008年

8 王立;中醫(yī)治療肝實質彌漫性損傷驗案[N];農村醫(yī)藥報（漢）;2009年

9 周萍;為啥甲狀腺會腫大[N];民族醫(yī)藥報;2001年

10 張禹;何謂應激性潰瘍[N];家庭醫(yī)生報;2006年

相關博士學位論文 前10條

1 尹衛(wèi)東;環(huán)孢霉素A治療大鼠彌漫性軸索損傷的實驗研究[D];中國人民解放軍軍醫(yī)進修學院;2002年

2 吳勇;纖維連接蛋白及其相關多肽對敗血癥及彌漫性血管內凝血的實驗研究[D];福建醫(yī)科大學;2002年

3 馮海峰;彌漫性大細胞性B細胞型非霍奇金淋巴瘤PTEN基因突變的研究[D];暨南大學;2001年

4 鄧昊;對一個彌漫性淺表性光敏性汗孔角化癥家系致病基因的定位和對遲發(fā)型2型糖尿病易感基因的研究[D];中南大學;2003年

5 王怡;異源雙鏈DNA體外錯配修復功能檢測模型的構建及彌漫性大B細胞性淋巴瘤中錯配修復系統(tǒng)的分析[D];復旦大學;2004年

6 吳敬杰;大鼠新型閉合性顱腦損傷模型的實驗研究[D];四川大學;2006年

7 田月琴;擴張性心肌病和缺血性心肌病心肌灌注、代謝及功能的綜合評價[D];中國協(xié)和醫(yī)科大學;1999年

8 孫曉川;彌漫性軸索損傷的實驗研究和影像學研究[D];重慶醫(yī)科大學;2004年

9 王

本文編號：2243630