| In this study,we used Gray scale ultrasound,Doppler ultrasound technology,for the clinical diagnosis of autoimmune liver disease(autoimmune hepatitis and primary biliary cholangitis),the patients with hepatitis B virus were examined with ultrasonography,to observe the characteristics of three kinds of hepatitides and the characteristics of Doppler ultrasound,and compare the differences.Use the transient elastography,measured liver hardness of autoimmune hepatitis patients,primary biliary cholangitis patients and the patients with hepatitis B virus.Then,these patients were examined by using puncture biopsy device(Bard biopsy gun,14 G cut biopsy needle),and associated pathological fibrosis results and liver stiffness,to observe the characteristics of different pathological stages of liver stiffness in autoimmune hepatitis and primary biliary cholangitis and the patients with hepatitis B virus,to evaluate the diagnostic value.Part 1 Comparison of ultrasonic characteristics between autoimmune liver disease and viral hepatitis BObjective:Make the ultrasound examination in autoimmune hepatitis,primary biliary cholangitis and hepatitis B patients,analysis of the characteristics of Gray scale ultrasound and Doppler ultrasound,to investigate the value of ultrasonography in the diagnosis of autoimmune liver disease.Materials and Methods:A retrospective analysis from July 2015 to February 2017 in the hepatology department of Wuxi the Fifth People’s Hospital,60 cases of hepatitis B patients,60 cases of patients with autoimmune hepatitis,46 cases of primary biliary cholangitis of the ultrasound data,to compare the characteristics of Gray scale ultrasound and Doppler ultrasound in each hepatitis.Specific parameters include the maximum oblique diameter of right lobe,the length of left lobe and the anteroposterior diameter of left lobe,diameter of portal vein,diameter and thickness of spleen,the velocity of portal vein,the highest and the lowest velocity of hepatic artery,resistance index of hepatic artery,hepatic parenchymal echo,gallbladder change,intrahepatic bile duct changes,with or without abdominal lymph nodes,with or without ascites.Results:1.The liver and spleen size: autoimmune hepatitis > hepatitis B,primary biliary cholangitis > hepatitis B,the difference was statistically significant(P<0.05).2.In patients with autoimmune hepatitis,the thickness of the liver texture was uneven,and the rate of change in the appearance of frosted glass was 65%.Primary biliary cholangitis in patients with a fine granular texture of liver echo change rate of 63%.The occurrence rate of the two changes was higher than that of hepatitis B patients,the difference was statistically significant(P<0.05).3.Primary biliary cholangitis in patients with hepatic vein were thinner and unclear rate of 20%,the echo of intrahepatic bile duct was increased,and the occurrence rate of short-term echo was 37%.The occurrence rate of the two changes was higher than that of hepatitis B patients,the difference was statistically significant(P<0.05).4.Autoimmune hepatitis in patients with gallbladder wall thickening rate was 71%,primary biliary cholangitis in patients with gallbladder wall thickening rate was 83%,there were higher than hepatitis B patients with gallbladder wall thickening rate of 36%,the difference was statistically significant(P<0.05).5.Autoimmune hepatitis in patients with abdominal lymph node incidence rate was 10%,primary biliary cholangitis patients with abdominal lymph node incidence rate was 17%,were higher than that of hepatitis B patients with abdominal lymph node was 1.7%,the difference was statistically significant(P<0.05).6.The lowest flow rate of hepatic artery in patients with autoimmune hepatitis > the lowest flow rate of hepatic artery in patients with hepatitis B,the resistance index of patients with autoimmune hepatitis < the resistance index of patients with hepatitis B,Primary biliary cholangitis in patients with portal vein blood flow velocity < hepatitis B patients with portal vein blood flow velocity,the difference was statistically significant(P<0.05).Conclusion:1.Gray scale ultrasound,autoimmune hepatitis and primary biliary cholangitis in liver size,spleen size,liver echo,hepatic vein,biliary system,abdominal lymph node are different with hepatitis B.(1)Hepatitis B mainly as follows: the size of liver is normal,liver echo thickening,hepatic vein clear,gallbladder wall thickening and abdominal lymph nodes occurred at lower rate.(2)Autoimmune hepatitis mainly as follows:the enlargement of the liver and spleen,the uneven thickness of the liver parenchyma,the change of the glass like appearance,the thickening of the gallbladder wall,and the high incidence of abdominal lymph nodes.(3)Primary biliary cholangitis mainly as follows:the enlargement of liver and spleen,showed fine granular changes,hepatic vein diameter became fine and intrahepatic bile duct echo enhancement,gallbladder wall thickening,abdominal lymph nodes showed a higher rate.2.Doppler ultrasound,the minimum flow rate of hepatic artery increased,resistance index decreased,with unknown cause of liver damage,do not rule out the possibility of autoimmune hepatitis,for portal vein flow rate decreased,with unknown cause of liver damage,does not exclude primary biliary cholangitis.Part 2 Comparison of diagnostic value of transient elastography in autoimmune liver disease and viral hepatitis BObjective:To investigate the diagnostic value of transient elastography on autoimmune liver disease(autoimmune hepatitis,primary biliary cholangitis)and the patients with hepatitis B virus,comparison of three kinds of hepatitides in the diagnosis of the difference.Materials and Methods:A total of from July 2015 to February 2017 in the hepatology department of Wuxi the Fifth People’s Hospital,53 cases of hepatitis B patients,49 cases of patients with autoimmune hepatitis,27 cases of primary biliary cholangitis were examined by using the transient elastography,each patients were measured liver stiffnessthe,Then,the pathological examination of liver tissue was performed in all the patients,and the degree of pathological fibrosis stage was obtained,compare the differences.Resu Its:Liver stiffness measurement of hepatitis B:No fibrosis(S0):(6.30±0.47)k Pa;Mild to moderate fibrosis(S1-S2):(8.95±1.76)k Pa;Severe fibrosis(S3-S4):(18.57±5.29)k Pa.Liver stiffness measurement of autoimmune hepatitis:No fibrosis(S0):(6.28±0.40)k Pa;Mild to moderate fibrosis(S1-S2):(8.21±2.17)k Pa;Severe fibrosis(S3-S4):(13.78±3.90)k Pa.Liver stiffness measurement of primary biliary cholangitis:No fibrosis(S0):(6.60±0.53)k Pa;Mild to moderate fibrosis(S1-S2):(13.27±3.52)k Pa;Severe fibrosis(S3-S4):(23.90±3.12)k Pa.1.With the aggravation of pathological liver fibrosis,the liver stiffness measurement of the three kinds of hepatitides were gradually increased.2.There was no significant difference in pathological diagnosis of S0 among hepatitis B,autoimmune hepatitis and primary biliary cholangitis(P>0.05).There was no significant difference in pathological diagnosis of S1-S2 between hepatitis B and autoimmune hepatitis(P>0.05).There was a significant difference in liver stiffness between hepatitis B and primary biliary cholangitis(P<0.05).Pathological diagnosis of S3-S4,hepatitis B and autoimmune hepatitis and primary biliary cholangitis liver stiffness measurement difference were statistically significant(P<0.05).3.With the gradual aggravation of pathological damage,primary biliary cholangitis liver stiffness measurement changed the most,followed by hepatitis B,minimal change of autoimmune hepatitis.Conclusion:1.Transient elastography can noninvasively and quantitatively evaluate the degree of liver fibrosis in patients with liver disease,and provide an important basis for clinical diagnosis and treatment.2.The higher the degree of liver fibrosis was,the higher the liver stiffness was measured by transient elastography.3.The same pathological fibrosis staging,autoimmune hepatitis,primary biliary cholangitis and the hepatitis B liver stiffness measurement are different,can provide the basis for clinical diagnosis.4.According to different hepatitides,there are different reference standards for measuring the degree of liver injury by instantaneous elastography,and the liver damage degree can not be judged according to the same standard. |
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