慢性肝炎患者肝脏B超形态学、周围血细胞计数与肝纤维化分期之间的关系

摘要

目的探讨慢性病毒性肝炎患者肝脏B超形态学改变、周围血细胞计数与肝纤维化病理分期之间的关系.方法对120例慢性病毒性肝炎患者行B超引导下肝活检及肝组织学纤维化分期;B超检查测定门静脉为主(MPV)、脾静脉(SPV)宽度及脾脏厚度;同时检测周围血细胞计数.比较上述指标之间的关系.结果120例慢性肝炎患者肝纤维化分期结果为:S0期15例,S1期40例,S2期25例,S3期24例,S4期16例.从S1～S4期,MPV、SPV增宽及脾脏增厚的比率逐渐上升,但MPV、SPV增宽的比率各期差别不大(P＞0.05),而脾脏增厚的发生率各期差别较大(0.01＜P＜0.025).从S1～S4期,周围血红细胞(RBC)、白细胞(WBC)及血小板(PLT)计数逐渐下降,尤以PLT下降最明显,S3、S4期显著低于S1、S2期(P分别＜0.05、0.01),其中S4期已在正常下限以下.RBC,WBC在S1、S2、S3期之间并无显著性差异(P＞0.05),S4期则较前面各期显著下降(P分别＜0.05,0.01).结论肝脏B超形态学改变、周围血细胞计数对慢性肝炎患者早期肝纤维化的诊断价值是有限的.脾脏肿大、SPV增宽、PLT计数下降可能对较严重的肝纤维化(S3或S4期)的诊断有一定作用.%Objective: To discuss the relationships of the hepatic fibrosis stages, liver morphological changes with ultrasonography of type B, and the peripheral blood cell counts in chronic hepatitis. Methods: In the series, 120patients with chronic viral hepatitis were undertaken liver biopsy and determinated the pathological stages of hepatic fibrosis. The diameters of main portal vein, splenic vein and the size of spleen were measured by ultrasonography of type B. In addition, the perpheral blood cell counts were tested routinely. Results: The results of different hepatic fibrosis stages were S0 15, S1 40, S2 25, S3 24, and S4 16. From S1 to S4, the ratios of broadening of main portal vein, splenic vein and spcenormegaly increased gradually. But there were no significant differences on the ratios of broadening of main portal vein and splenic vein in the different stages (P ＞0.05), and there were significant difference on splenormegaly in the different stages (0.01 ＜P ＜0.025). In S4 (early liver cirrhosis stage), the ratios of splenormegaly and splenic vein broadening reached 43.8% and 25.0%. The peripheral blood cell counts also decreased gradually from S1 to S4, especially the platelet count, it decreased more significantly in S3 and S4 than S1and S2 (P ＜0.05 and P ＜0.01, respectively). Red cell and white cell counts of S4 decreased more significantly than S1, S2 and S3 (P ＜0.05 and 0.01 respectively). Conclusions: The value of diagnosing mild hepatic fibrosis with liver morphological changes with ultrasonography of type B, and the peripheral blood cell counts in chronic liver diseases are limited. Splenormegaly, splenic vein broadening, and the decrease of peripheral platelet count probably play significant roles on diagnosing the moderate and severe stages (S3 and S4) of hepatic fibrosis.