肝活检与B超诊断脂肪肝的对比研究

摘要

目的 评估肝活检与B超在脂肪肝诊断中的意义.方法 对比分析62例B超检查未诊断为脂肪肝但经肝穿刺活组织检查诊断为肝细胞脂肪变性患者的结果 ,并结合肝功能、血脂、血糖、体重指数进行分析.结果62例B超检查未诊断脂肪肝的患者,经肝穿刺活组织检查,提示肝细胞脂肪变性5％～33％.其中B超检查提示肝实质回声未见异常23例,肝实质回声稍增粗欠均18例,肝实质回声稍细密增强17例,肝脏弥漫性损伤4例,分别占37.01％、29.03％、27.42％、6.45％;病理提示5％≤肝脂肪变性≤19％有45例,B超检查提示肝实质回声未见异常18例,肝实质回声稍增粗欠均8例,肝实质回声稍细密增强17例,肝脏弥漫性损伤2例,B超改变以肝实质回声未见异常和肝实质回声稍细密增强为主;病理提示20％≤肝脂肪变性≤33％有17例,B超检查提示肝实质回声未见异常6例,肝实质回声稍增粗欠均5例,肝实质回声稍细密增强5例,肝脏弥漫性损伤1例,B超改变主要表现为肝实质回声未见异常、肝实质回声稍细密增强和肝实质回声稍增粗欠均.分析患者的肝功能、体重指数、血脂和血糖对B超改变的影响,通过无序多分类Logistic回归分析发现谷氨酰转移酶、碱性磷酸酶、体重指数、甘油三酯和低密度脂蛋白胆固醇的值越大,越容易导致肝脏弥漫性损伤;脂肪变性程度越大越容易导致肝脏弥漫性损伤.结论 对脂肪肝的诊断,当肝细胞脂肪变性低于1/3时,B超检查不能表现出脂肪肝的特征性改变,应密切观察B超或行肝穿刺组织学检查以明确脂肪肝诊断.%Objective To evaluate the significance of liver biopsy and B ultrasonograpgy in the diagnosis of fatty liver. Methods The results of 62 patients with liver steatosis diagnosed by liver puncture biopsy but not by B-ultrasonograpgy were contrastively analyzed and combined with liver function, blood lipids, blood glucose, and body mass index. Results The 62 cases which were not diagnosed as fatty liver by B-ultrasonograpgy were proved to be 5％-33％liver steatosis after liver puncture biopsy. Among the 62 cases, 23 cases were indicated by the B-ultrasonograpgy that the liver parenchyma echo did not see abnormalities, 18 cases showed the liver parenchyma echo slightly was enlarged, 17 cases showed the liver parenchyma echo density was a bit enhanced and 4 cases were diffuse liver damage,which respectively were 37.01％、29.03％、27.42％and 6.45％. Pathologically it indicated that 45 cases were 5％≤liver steatosis≤19％. Among the 45 cases, 18 cases were indicated by the B-ultrasonograpgy that the liver parenchyma echo was not seen abnormalities, 8 cases showed the liver parenchyma echo slightly was enlarged, 17 cases showed the liver parenchyma echo density was a bit enhanced, and 2 cases were diffuse liver damage, and the change of ultrasound was mainly showed by the liver parenchyma echo not seen abnormalities and the enhanced liver parenchyma echo density. Pathologically it indicated that 17 cases were 20％≤liver steatosis≤33％, 6 cases were indicated by the B-ultrasonograpgy that the liver parenchyma echo did not see abnormalities, 5 cases showed the liver parenchyma echo slightly was enlarged, 5 cases showed the liver parenchyma echo density was a bit enhanced, and 1 case was diffuse liver damage, and the change of ultrasound was mainly showed by the liver parenchyma echo not seen abnormalities, the slightly enlarged liver parenchyma echo and the enhanced liver parenchyma echo density. By analyzing the influence to the ultrasound changes by patients' liver function, body mass index, blood fat and blood sugar, and with logistic regression analysis through a disorderly classification, it was found that the larger value of the glutamine transferase, alkaline phosphatase, body mass index, triglyceride and low density lipoprotein cholesterol, the higher possibility of diffuse liver damage, and the higher level of fatty degeneration, the higher possibility of diffuse liver damage. Conclusion In the diagnosis of fatty liver, when the fatty degeneration is below 1/3, B-ultrasonic examination can't show characteristic changes of fatty liver. It should be closely observed or take liver puncture biopsy to make a definite diagnosis of fatty liver.