超声衰减成像系数诊断非酒精性脂肪性肝病患者肝脏脂肪变性程度价值研究*

doi:10.3969/j.issn.1672-5069.2025.02.011

摘要/Abstract

摘要： 目的分析超声衰减成像系数诊断非酒精性脂肪性肝病(NAFLD)患者肝脏脂肪变性程度的价值。方法 2023年1月～2024年9月我院诊治的NAFLD患者91例,均接受肝穿刺活检和超声衰减参数成像(UGAP)检查,测量衰减系数(AC),应用受试者工作特征曲线(ROC)下面积(AUC)分析AC诊断NAFLD患者肝脏脂肪变性程度的效能。结果在91例NAFLD患者中,经肝穿刺活检组织病理学检查诊断S1级肝脂肪变45例,S2级肝脂肪变28例和S3级肝脂肪变18例;S3级肝脂肪变患者血清TC、TG、ALT和AST水平分别为(6.4±1.3)mmol/L、(3.3±1.0)mmol/L、(78.4±15.2)U/L和(62.9±12.6)U/L,均显著高于S1级肝脂肪变患者【分别为(4.7±1.1)mmol/L、(1.8±0.7)mmol/L、(27.1±6.3)U/L和(25.6±5.7)U/L,P<0.05】或S2级肝脂肪变患者【分别为(5.6±1.4)mmol/L、(2.6±0.8)mmol/L、(42.5±9.6)U/L和(37.2±7.4)U/L,P<0.05】,而血清HDL-C水平为(0.8±0.3)mmol/L,显著低于S1级肝脂肪变患者【(1.2±0.4)mmol/L,P<0.05】或S2级肝脂肪变患者【(1.0±0.3)mmol/L,P<0.05】;S3级肝脂肪变患者AC为(0.8±0.1)dB/cm/MHz,显著大于S1级【(0.6±0.1) dB/cm/MHz,P<0.05】或S2级肝脂肪变患者【(0.7±0.1)dB/cm/MHz,P<0.05】;ROC曲线分析显示,以0.7dB/cm/MHz为截断点,AC诊断NAFLD患者≥S2级肝脂肪变的AUC为0.854(95% CI:0.772～0.935),其敏感度为82.6%,特异度为88.9%;以0.8dB/cm/MHz为截断点,AC诊断NAFLD患者S3级肝脂肪变的AUC为0.834(95% CI:0.699～0.970),其敏感度为77.8%,特异度为93.2%(P<0.05)。结论使用超声检测AC也不失为一种初步诊断NAFLD患者肝脏脂肪变性的良好方法。

关键词: 非酒精性脂肪性肝病, 肝脏脂肪变性, 超声衰减成像系数, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance ofultrasound-guided attenuation parameter (UGAP)in predicting hepatic steatosis in patients with non-alcoholic fatty liver disease(NAFLD). Methods 91 patients with NAFLD were enrolled in our hospital between January 2023 and September 2024, and all underwent liver biopsy for liver steatosis grading andUGAP for measuring attenuation coefficient(AC). Receiver operating characteristic curve (ROC) and area under the curve (AUC) was adopted to analyze diagnostic efficacy. Results Of 91 patients withNAFLD, liver histo-pathological examination showed liver steatosis S1 grade in 45 cases, S2 in 28 cases and S3 in 18 cases; serum TC, TG, ALT and AST levels in patients with S3 liver steatosis were (6.4±1.3)mmol/L, (3.3±1.0)mmol/L, (78.4±15.2)U/L and (62.9±12.6)U/L, all significantly higher than [(4.7±1.1)mmol/L, (1.8±0.7)mmol/L, (27.1±6.3)U/L and (25.6±5.7)U/L, respectively, P<0.05] in patients with S1 or [(5.6±1.4)mmol/L, (2.6±0.8)mmol/L, (42.5±9.6)U/L and (37.2±7.4)U/L, respectively, P<0.05] in patients with S2, while serum HDL-C level was (0.8±0.3)mmol/L, much lower than [(1.2±0.4)mmol/L, P<0.05] in patients with S1 or [(1.0±0.3)mmol/L, P<0.05] in patients with S2; the AC in patients with S3 was (0.8±0.1)dB/cm/MHz, much greater than [(0.6±0.1) dB/cm/MHz, P<0.05] in patients with S1 or [(0.7±0.1)dB/cm/MHz, P<0.05] in patients with S2; ROC analysis showed that the AUC was 0.854(95% CI:0.772-0.935), with sensitivity (Se) of 82.6% and specificity (Sp) of 88.9%, when AC equal to or greater than 0.7dB/cm/MHz as the cut-off-value in predicting liver steatosis ≥S2, and the AUC was 0.834(95% CI:0.699-0.970), with Se of 77.8% and Sp of 93.2%(P<0.05), when the AC greater than 0.8dB/cm/MHz as the cut-off-value in predicting liver steatosis S3. Conclusion AC obtained by conventional ultrasound has a satisfactory clinical application value in the diagnosis of hepatic steatosis in patients with NAFLD, which might help screening preliminarily.

Key words: Non-alcoholic fatty liver disease, Liver steatosis, Ultrasound attenuation imaging coefficient, Diagnosis

韩悦, 翟菲菲, 张晴, 孟慧敏. 超声衰减成像系数诊断非酒精性脂肪性肝病患者肝脏脂肪变性程度价值研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 202-205.

Han Yue, Zhai Feifei, Zhang Qing, et al. Diagnostic performance of ultrasound attenuation imaging coefficient in predicting hepatic steatosis in patients with non-alcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2025, 28(2): 202-205.

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超声衰减成像系数诊断非酒精性脂肪性肝病患者肝脏脂肪变性程度价值研究^*

Diagnostic performance of ultrasound attenuation imaging coefficient in predicting hepatic steatosis in patients with non-alcoholic fatty liver disease

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