Comparisons of Ultrasonography and Liver Function Tests in the Detection of Liver Cirrhosis Due to Viral Hepatitis B or C

比較超音波掃描術及肝功能檢驗於偵測B型或C型肝炎病毒導致之肝硬化上之價值

楊培鎮(Pei-Jenn Yang) ； 楊培銘(Pei-Ming Yang) ； 賴明陽(Ming-Yang Lai) ； 黃冠棠(Guan-Tarn Huang) ； 許金川(Jin-Chuan Sheu) ； 王德宏(Teh-Hong Wang) ； 陳定信(Ding-Shinn Chen)

《中華民國消化系醫學會雜誌》 12卷2期 (1995/06) Pp. 180-188

https://doi.org/10.6557/GJTa.199506_12(2).0003

摘要

肝硬化患者主要死於其併發症。在併發症發生之前，肝硬化患者通常沒有症狀；因此，對於慢性病毒性肝炎患者，偵測其肝內是否已進行至肝硬化是相當重要的。為了評估超音波掃描術，血清GOT/GPT比值及血清球蛋白值三種非侵襲性檢查法在偵測肝硬化存在之敏感度，我們收集了80位經肝穿刺證實之肝硬化患者加以研究，其中50位為B型肝炎病毒所導致，另外30位則是由C型肝炎病毒造成。超音波診斷肝硬化之標準包含結節性肝表面，粗糙之肝內實質及肝靜脈之不規則狹窄。血清GOT/GPT比值及血清球蛋白值之診斷界限係採慢性活動性肝炎患者之平均值加上其標準差之2倍；因此，對於慢性B型肝炎患者，診斷其肝硬化存在之界限分別為0.94及3.8 gm/dl，慢性C型肝炎患者則為1.25及4.7 gm/dl。超音波掃描術，血清GOT/GPT比值及血清球蛋白值偵測肝硬化之敏感度，在B型肝炎病毒組分別為88%，74%及28%；在C型肝炎病毒組分別為70%，33%及3.3%。兩種血清學檢查偵測肝硬化之敏感度在兩組肝硬化病人間具有統計學上有意義之差異，但超音波掃描術之敏感度則兩組間無明顯差異。B型肝炎病毒導致之肝硬化患者中有23位之肝功能正常，其中20位可用超音波掃描術將其內之肝硬化偵測出來。我們的結論是：對於慢性病毒性肝炎患者，偵測其內肝硬化存在與否之敏感度，超音波掃描術遠優於兩項血清學檢查。即使在Child A代償良好之病患，超音波掃描術仍能將其大部分偵測出來。血清GOT/GPT比值偵測B型肝炎病毒導致之肝硬化也有相當不錯之敏感度。

關鍵字

肝硬化 ； 超音波掃描術 ； 肝功能檢驗 ； 病毒性肝炎

並列摘要

Complications are major causes of death in cirrhotic patients. Because cirrhotic patients are often asymptomatic before complications occur, it is important to detect the development of cirrhosis in victims of chronic viral hepatitis. To evaluate the usefulness of ultrasonography (US), serum GOT/GPT ratio and serum globulin level in the detection of liver cirrhosis, 80 patients with cirrhosis induced by either hepatitis B virus (LC-B, N=50) or hepatitis C virus (LC-C, N=30) were studied. Nodular surface, coarse echotexture and irregularly narrowed hepatic veins were the three diagnostic criteria of US. The cut-off values (mean +2 S.D. of data in patients with chronic active hepatitis) of serum GOT/GPT ratio and globulin level in the diagnosis of liver cirrhosis were 0.94 and 3.8 gm/dl respectively for LC-B and 1.25 and 4.7 gm/dl respectively for LC-C. The sensitivity of US, serum GOT/GPT ratio and globulin level in the detection of liver cirrhosis was 88%, 74% and 28% respectively for LC-B and 70%, 33% and 3.3% respectively for LC-C. The difference in the sensitivity of the two biochemical tests between LC-B and LC-C patients was statistically significant; however, that of US was not significant. Of the 23 cirrhotic patients whose liver function tests were within normal limits, 20 could be detected with US. We conclude that US is much better in the detection of liver cirrhosis than serum GOT/GPT ratio as well as globulin level in both groups of cirrhotic patients even though the cirrhotic patients are in well-compensated Child A status. Serum GOT/GPT ratio is also fair in disclosing liver cirrhosis for patients of LC-B.

並列關鍵字

liver cirrhosis ； ultrasonography ； liver function test ； viral hepatitis