FibroScan、MRI-PDFF和FAST评分识别高危非酒精性脂肪性肝炎患者临床应用研究*

doi:10.3969/j.issn.1672-5069.2024.05.014

实用肝脏病杂志 ›› 2024, Vol. 27 ›› Issue (5): 701-704.doi: 10.3969/j.issn.1672-5069.2024.05.014

FibroScan、MRI-PDFF和FAST评分识别高危非酒精性脂肪性肝炎患者临床应用研究^*

杨逸铭, 李晓环, 刘玉品, 欧金龙, 黎胜, 石美凤, 汪印强

510120 广州市广州中医药大学第二临床医学院/广东省中医院影像科

收稿日期:2023-12-26 出版日期:2024-09-10 发布日期:2024-09-09
通讯作者: 刘玉品,E-mail:1034069077@qq.com
作者简介:杨逸铭,男,32岁,硕士研究生,主治医师。主要从事腹部影像学诊断研究。E-mail:1075341326@qq.com
基金资助:
^*国家卫健委-广东省共建中医湿证国家重点实验室开放课题(编号:SZ2021KF08); 横向课题(编号:2019KT1217)

Increased liver stiffness measurement in patients with non-alcoholic fatty liver diseases might hints high-risk NASH

Yang Yiming, Li Xiaohuan, Liu Yupin, et al

Department of Radiology, Provincial Hospital of Traditional Chinese Medicine, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510210, Guangdong Province, China

Received:2023-12-26 Online:2024-09-10 Published:2024-09-09

摘要/Abstract

摘要： 目的探讨瞬时弹性成像(FibroScan)、磁共振质子密度脂肪分数(MRI-PDFF)和FAST评分识别高危非酒精性脂肪性肝炎(NASH)患者的应用价值。方法 2017年6月～2021年12月我院诊治的非酒精性脂肪肝病(NAFLD)患者107例,均接受肝活检和MRI-PDFF、FibroScan和血清学检查,计算FAST、FIB-4和APRI指数。采用单因素和多因素Logistic回归分析,应用受试者工作特征(ROC)曲线分析指标识别高危NASH患者的诊断效能。结果在107例NAFLD患者中,经肝组织病理学检查诊断高危非酒精性脂肪性肝炎(NASH)患者13例(12.1%),单纯性脂肪肝和非高危NASH患者94例(87.9%);高危NASH组LSM、FAST评分和APRI指数显著高于非高危组(P＜0.05); 多因素Logistic回归分析显示,FibroScan检测的肝脏硬度 (LSM)是高危NASH患者的独立影响因素(P＜0.05);ROC曲线分析显示LSM、FAST和APRI识别高危NASH患者有统计学意义(P＜0.05),其曲线下面积 (AUC)分别为0.795、0.713和0.682,以LSM的诊断效能最优,其排除截断点诊断的敏感度和特异度分别为92.3%和54.3%,而纳入截断点诊断则为53.8%和90.4%。结论对于FibroScan检测诊断的NAFLD患者,其LSM也同期升高高度提示NASH的存在,应进一步检查,以期早期干预。

关键词: 非酒精性脂肪性肝炎, 瞬时弹性成像, 磁共振质子密度脂肪分数, FAST评分, 诊断

Abstract: Objective The purpose of this study was to explore the diagnostic performance of FibroScan, magnetic resonance imaging proton density fat-fraction (MRI-PDFF) and FibroScan-AST(FAST)score in judging patients with high risk non-alcoholic steatohepatitis (NASH) from those with non-alcoholic fatty liver diseases (NAFLD). Mthods A total of 107 patients with NAFLD were encountered in our hospital between June 2017 and December 2021, and all patients underwent liver biopsies. FibroScan, MRI-PDFF and serological detection were completed and three non-invasive models of FAST, FIB-4 and APRI were calculated. Univariate and multivariate Logistic regression analysis was used to screen out factors impacting high-risk NASH. The diagnostic performance of relevant parameters and three non-invasive models to identify high risk NASH was analyzed by ROC curve. Result Of 107 patients with NAFLD, the histo-pathological examination showed high risk NASH in 13 cases (12.1%), and simple alcoholic fatty liver and non-high risk NASH in 94 cases (87.9%); liver stiffness measurement (LSM) by Fibroscan, FAST score and aspartate aminotransferase/platelets (APRI) in patients with high risk NASH were significantly higher than in those with non-high risk NASH (P＜0.05);multivariate Logistic regression analysis showed that only the LSM was the independent risk factor impacting high risk NASH(P＜0.05);ROC analysis demonstrated that the LSM, FAST and APRI could identify high risk NASH(P＜0.05), with AUCs of 0.795, 0.713 and 0.682, and the LSM got the optimal diagnostic efficacy, with sensitivity (Se) and specificity (Sp) of 92.3%and 54.3% based on exclusion cut-off-value, and with Se and Sp of 53.8%and 90.4% based on inclusion cut-off-value. Conclusion The simultaneous increased LSM in patients with NAFLD hints existence of NASH, which might help clinicians make appropriate measures to tackle it.

Key words: Nonalcoholic Steatohepatitis, FibroScan, Magnetic resonance imaging proton density fat-fraction, FAST score, Diagnostic test

杨逸铭, 李晓环, 刘玉品, 欧金龙, 黎胜, 石美凤, 汪印强. FibroScan、MRI-PDFF和FAST评分识别高危非酒精性脂肪性肝炎患者临床应用研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 701-704.

Yang Yiming, Li Xiaohuan, Liu Yupin, et al. Increased liver stiffness measurement in patients with non-alcoholic fatty liver diseases might hints high-risk NASH[J]. Journal of Practical Hepatology, 2024, 27(5): 701-704.

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FibroScan、MRI-PDFF和FAST评分识别高危非酒精性脂肪性肝炎患者临床应用研究^*

Increased liver stiffness measurement in patients with non-alcoholic fatty liver diseases might hints high-risk NASH

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