Objective: To analyze the incidence and risk factors of benign liver space-occupying mass in patients with chronic hepatitis B (CHB) and the ultrasound features that differentiate these masses from small hepatocellular carcinoma.
Methods: We retrospectively analyzed the color Doppler and clinical data of 17 721 patients with CHB treated in the Hepatology Unit of Nanfang Hospital between January, 2016 and December, 2017. The data were compared with those of 21629 healthy control subjects undergoing routine physical examination in the Center of Heath Management of Nanfang Hospital during the same period.
Results: Compared with the control subjects, the patients with CHB had significantly higher incidences of hepatic cysts (11.8% vs 8.7%, P < 0.05), hepatic hemangioma (8.2% vs 1.6%, P < 0.05) and hepatic cirrhosis nodules (20.6% vs 2.4%, P < 0.05). The incidences of hepatic cysts and cirrhosis nodules increased with age and was significantly higher in male than in female patients (P < 0.001). The highest incidence of hepatic hemangioma was found in CHB patients aged 30-49 years without a gender difference (P>0.05). Sonographically, the benign liver masses commonly showed homogeneous echo within the lesion with clear boundaries and regular shape. Hepatic hemangioma was distinctively hyperechoic in 83.32% (1579/1895) of the patients, while small hepatocellular carcinoma presented with weaker peripheral and internal blood flow signals with a lower flow velocity in the arteries and a higher flow velocity in the portal vein. Liver cirrhosis nodules mostly showed a mixture of strong and weak echoes (79.60%; 7637/9595) without blood flow signal within or around the nodule; an increased volume of the nodule accompanied by heterogeneous echoes within the nodule indicated an increased probability of malignant lesion. Hepatic cysts often displayed no echo within the lesion, but the echo could be enhanced posteriorly.
Conclusions: The patients with CHB are at a significantly higher risk of developing hepatic cysts, hepatic hemangiomas and hepatic cirrhosis nodules than the control population, and an older age and the male gender are associated with a higher incidence of hepatic cysts or cirrhosis. The differences in the sonographic and hemodynamic features can help to differentiate hepatic benign mass from malignant lesions, and kinetic changes in sonography can be used to monitor potential malignant transformation of the cirrhotic lesions.
目的: 调查慢性乙型肝炎（CHB）患者中肝脏良性占位性病变的发病率，以普通人群为对照，分析其高发的风险因素及其与小肝癌的鉴别要点。
方法: 回顾性分析2016年1月~2017年12月于南方医院肝脏中心就诊的17 721例CHB患者的影像学资料及相关临床资料，与同期在南方医院健康管理中心行常规体检的21629例普通人群进行比较分析。
结果: 与普通人群相比，CHB患者的肝囊肿、肝血管瘤、肝硬化结节发病率更高，局灶性结节性增生的发病率更低（分别为11.8% vs 8.7%、8.2% vs 1.6%、20.6% vs 2.4%、0.006% vs 0.042%，均P < 0.05），肝细胞腺瘤的发病率无统计学差异（P>0.05）。肝囊肿和肝硬化结节的发病率随年龄增长而升高，其中男性发病率高于女性（P < 0.001）；肝血管瘤的发病率在30~49岁患者中最高，无性别差异（P>0.05）。肝脏良性占位的超声表现多为内部回声均匀，边界清晰，形态规则：肝血管瘤常为高回声（83.32%，1579/1895），与小肝癌相比，它的四周与内部血流信号较少，固有动脉流速更低，门静脉流速更高；肝硬化结节多为强、弱混合回声（79.60%，7637/9595），结节内部和周边无血流信号，当其体积增大，伴内部回声发生不均匀改变时，提示恶变概率升高；肝囊肿常表现为内部无回声，后方回声增强。
结论: CHB患者较普通人群更易发生肝囊肿、肝血管瘤和肝硬化结节；其发病率与年龄、性别相关。本研究总结的肝脏良、恶性占位，特别是肝硬化结节的超声声学和血流学特征，能够为早期识别肝脏占位的性质提供重要线索和依据。
Keywords: benign liver mass; chronic hepatitis B; incidence.