FibroTouch©和CT定量检查诊断脂肪肝人群NASH效能研究*

doi:10.3969/j.issn.1672-5069.2025.02.010

摘要/Abstract

摘要： 目的探讨FibroTouch^©和CT定量检查非酒精性脂肪性肝病(NAFLD)人群非酒精性脂肪性肝炎(NASH)的效能。方法 2022年1月～2024年1月我院收治的NAFLD患者150例,均行肝穿刺活检、FibroTouch^©和CT定量检查。FibroTouch^©检测肝脏受控衰减参数(CAP)和肝脏硬度检测(LSM),CT定量检测内脏脂肪组织面积(VAT)、皮下脂肪组织面积(SAT)、肝/脾CT值和腹部脂肪总面积(TAT)。以Kappa值分析两种方法与肝组织病理学检查结果的一致性。绘制受试者工作特征(ROC)曲线分析指标的诊断效能。结果肝组织病理学检查显示单纯性脂肪肝(SFL)109例和NASH 41例;以肝组织学诊断为金标准,FibroTouch^©与肝组织病理学诊断的Kappa值为0.743,一致性较高,其灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为87.8%、89.9%、89.3%、76.6%和95.2%,而CT定量检查诊断分别为85.4%、87.2%、86.7%、71.4%和94.1%;NASH组CAP、LSM和TAT分别为(303.5±12.7)db/m、(11.1±2.9)kPa和(473.1±80.5)cm²,均显著高于SFL组【分别为(269.4±17.2)db/m、(6.4±1.6)kPa和(358.1±72.0)cm²,P＜0.05】,而肝/脾CT值为(0.4±0.1),显著低于SFL组【(0.8±0.2),P＜0.05】;经ROC曲线分析显示,CAP、LSM、肝/脾CT值和TAT诊断NASH的曲线下面积(AUC)分别为0.861、0.864、0.803和0.851,均有很好的诊断效能(P＜0.05)。结论 FibroTouch^©和CT定量检查指标自NAFLD人群中筛选NASH患者具有很大的临床应用价值,值得深入研究。

关键词: 非酒精性脂肪性肝病, 非酒精性脂肪性肝炎, 受控衰减参数, 肝脏硬度检测, 腹部脂肪总面积, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of controlled attenuation parameter (CAP), liver stiffness measurement (LSM) and total adipose tissue (TAT) in screening patients with nonalcoholic steatohepatitis (NASH) from individuals with nonalcoholic fatty liver diseases (NAFLD). Methods 150 patients with NAFLD were enrolled in our hospital between January 2022 and January 2024, and all underwent liver biopsy. CAP and LSM were determined by FibroTouch^©, and quantitative TAT and ratio of liver/spleen CT value were obtained by CT scan. The diagnosis consistency between FibroTouch^© and CT scan and liver biopsy was analyzed by Kappa values. Area under receiver operating characteristic (ROC) curves (AUC) was applied to evaluate diagnostic efficacy. Results Liver histo-pathological examination found simple fatty liver (SFL) in 109 cases and NASH in 41 cases in our series; taking pathological diagnosis as golden standard, the good diagnostic consistence was found between FibroTouch^© or CT quantitative scan (Kappa=0.743, or Kappa=0.684), with sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 87.8%, 89.9%, 89.3%, 76.6% and 95.2%, or 85.4%, 87.2%, 86.7%, 71.4% and 94.1%; CAP, LSM and TAT in patients with NASH were (303.5±12.7)db/m, (11.1±2.9)kPa and (473.1±80.5)cm², all significantly higher than [(269.4±17.2)db/m, (6.4±1.6)kPa and (358.1±72.0)cm², respectively, P＜0.05], while ratio of liver/spleen CT value was (0.4±0.1), much lower than [(0.8±0.2), P＜0.05] in patients with SFL; ROC analysis showed the AUCs were 0.861, 0.864, 0.803 and 0.851, all with a satisfactory diagnostic efficacy (P＜0.05), when CAP, LSM, ratio of liver/spleen CT value and TAT were applied to predict NASH from individuals with NAFLD. Conclusion FibroTouch^© and CT quantitative scan both have certain diagnostic performance in assessing NASH in population of NAFLD, and warrants further clinical investigation.

Key words: Nonalcoholic fatty liver disease, Nonalcoholic steatohepatitis, Controlled attenuation parameter, Liver stiffness measurement, Total adipose tissue, Diagnosis

Wang Xiaoyan, Cui Wenxing, Chen Chao. Controlled attenuation parameter, liver stiffness measurement and total adipose tissue in screening patients with nonalcoholic steatohepatitis[J]. Journal of Practical Hepatology, 2025, 28(2): 198-201.

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FibroTouch^©和CT定量检查诊断脂肪肝人群NASH效能研究^*

Controlled attenuation parameter, liver stiffness measurement and total adipose tissue in screening patients with nonalcoholic steatohepatitis

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