超声声衰减系数联合血清ALT/AST比值评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究*

doi:10.3969/j.issn.1672-5069.2025.03.014

摘要/Abstract

摘要： 目的探讨应用超声声衰减系数(AC)联合血清丙氨酸氨基转移酶(ALT)/天冬氨酸氨基转移酶(AST)比值评估非酒精性脂肪性肝病(NAFLD)患者肝脂肪变程度的效能。方法 2021年5月～2024年5月我院收治的NAFLD患者70例和30例健康体检者,NAFLD患者均接受肝活检,使用超声声衰减成像(ATI)技术测定AC值,常规行血生化指标检测,绘制受试者工作特征曲线(ROC)分析指标的诊断效能。结果在本组70例NAFLD患者中,组织病理学检查诊断轻度脂肪变20例,中度脂肪变28例和重度脂肪变22例;重度组AC值为(1.1±0.4)dB·cm^-1·MHz^-1,显著高于中度组【(0.8±0.3)dB·cm^-1·MHz^-1,P＜0.05】或轻度组【(0.6±0.2)dB·cm^-1·MHz^-1,P<0.05】和健康人组【(0.5±0.1)dB·cm^-1·MHz^-1,P＜0.05】,血清ALT/AST比值为(1.0±0.1),显著低于中度组【(1.3±0.2),P＜0.05】或轻度组【(1.7±0.4),P＜0.05】和健康人组【(1.8±0.5),P＜0.05】; ROC曲线分析显示,分别以AC值=0.79 dB·cm^-1·MHz^-1和血清ALT/AST比值=1.28为截断点,两者联合诊断中度肝脂肪变的AUC=0.882(95%CI:0.745～0.961),其灵敏度为92.9%,特异度为75.0%,显著优于两者单独诊断(P＜0.05); 分别以AC值=1.08 dB·cm^-1·MHz^-1和血清ALT/AST比值=1.00为截断点,两者联合诊断重度肝脂肪变的AUC=0.902(95%CI:0.804～0.978),其灵敏度为95.5%,特异度为85.0%,显著优于两者单独诊断(P＜0.05)。结论 AC联合血清ALT/AST比值可帮助临床初步评估NAFLD患者肝脂肪变程度,为进一步诊治提供线索。

关键词: 非酒精性脂肪性肝病, 肝脂肪变, 超声声衰减系数, 丙氨酸氨基转移酶/天冬氨酸氨基转移酶比值, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of ultrasound attenuation coefficient (AC) and serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio in evaluating liver steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods 70 patients with NAFLD and 30 volunteers for healthy physical examination were admitted to our hospital between May 2021 and May 2024, and all patients with NAFLD received liver biopsies. Ultrasonic attenuation imaging (ATI) was performed to measure AC, and serum ALT and AST levels were routinely detected. Receiver operating characteristic (ROC) curves were applied to analyze predicting efficacy of AC and serum ALT/AST ratio combination for liver steatosis in patients with NAFLD. Results Of 70 patients with NAFLD in our series, liver histo-pathological examination showed liver steatosis of mild degree in 20 cases, moderate in 28 cases and severe in 22 cases; AC in patients with severe liver steatosis was (1.1±0.4)dB·cm^-1·MHz^-1, much higher than [(0.8±0.3)dB·cm^-1·MHz^-1, P＜0.05] in moderate or [(0.6±0.2)dB·cm^-1·MHz^-1, P<0.05] in mild and [(0.5±0.1)dB·cm^-1·MHz^-1, P＜0.05] in healthy persons, and serum ALT/AST ratio was (1.0±0.1), much lower than [(1.3±0.2), P＜0.05] in moderate or [(1.7±0.4), P＜0.05] in mild and [(1.8±0.5), P＜0.05] in healthy control; ROC analysis showed that the AUC was 0.882(95%CI:0.745-0.961), with sensitivity (Se) of 92.9% and specificity (Sp) of 75.0%, when AC and ALT/AST ratio combination in predicting moderate liver steatosis (P＜0.05), and the AUC was 0.902(95%CI:0.804-0.978), with Se of 95.5% and Sp of 85.0%, when the two parameters combined in predicting severe liver steatosis, much superior to any parameter doing alone (P＜0.05). Conclusion Combination of AC and serum ALT/AST ratio might help clinicians for early liver steatosis screening, which needs further clinical investigation.

Key words: Nonalcoholic fatty liver disease, Liver steatosis, Ultrasound attenuation coefficient, Serum alanine aminotransferase/aspartate aminotransferase ratio, Diagnosis

马晨曦, 许静, 王艳秋. 超声声衰减系数联合血清ALT/AST比值评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 374-377.

Ma Chengxi, Xu Jing, Wang Yanqiu. Ultrasound attenuation coefficient and serumALT/AST ratio in evaluating liver steatosis in patients with nonalcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2025, 28(3): 374-377.

参考文献

[1] De A, Bhagat N, Mehta M, et al. Metabolic dysfunction-associated steatotic liver disease (MASLD) definition is better than MAFLD criteria for lean patients with NAFLD. J Hepatol, 2024, 80(2):e61-e62.
[2] Burra P, Bizzaro D, Gonta A, et al. Special interest group gender in hepatology of the italian association for the study of the liver (AISF). clinical impact of sexual dimorphism in non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Liver Int, 2021, 41(8):1713-1733.
[3] Kalogirou MS, Giouleme O. Growing challenge of post-liver transplantation non-alcoholic fatty liver disease. World J Transplant, 2022, 12(9):281-287.
[4] 陈洁,张波.超声定量评估非酒精性脂肪性肝病肝脏脂肪变性的研究进展.中国医学科学院学报, 2021, 43(5):827-832.
[5] 朱桂新,梁永超,武爽.超声声衰减成像技术在评估非酒精性脂肪性肝病的初步探讨.中国超声医学杂志, 2021, 37(2):170-173.
[6] Huynh T, Ma S, Hu KQ. HCV direct acting antiviral treatment leads to highly durable rates of ALT and AST lower than 30/19 criteria and improved APRI and FIB-4 scores. Hepatol Commun, 2022, 6(12):3496-3504.
[7] 姚志祥,周悦,刘览.CG和TBA联合DeRitis比值水平在肝脏系统相关疾病早期诊断中临床研究.标记免疫分析与临床, 2021, 28(11):1909-1915.
[8] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会,范建高,等.非酒精性脂肪性肝病防治指南(2018年更新版).实用肝脏病杂志, 2018, 21(2):30-39.
[9] Teng ML, Ng CH, Huang DQ, et al. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol, 2023, 29(l):S32-S42.
[10] Fang T, Wang H, Pan X, et al. Mouse models of nonalcoholic fatty liver disease (NAFLD): pathomechanisms and pharmacotherapies. Int J Biol Sci, 2022, 18(15):5681-5697.
[11] Vlock EM, Karanjit S, Talmon G, et al. Reduction of polyunsaturated fatty acids with Tumor progression in a lean non-alcoholic steatohepatitis-associated hepatocellular carcinoma mouse model. J Cancer, 2020, 11(19):5536-5546.
[12] Suppli MP, Rigbolt KTG, Veidal SS, et al. Hepatic transcriptome signatures in patients with varying degrees of nonalcoholic fatty liver disease compared with healthy normal-weight individuals. Am J Physiol Gastrointest Liver Physiol, 2019, 316(4):G462-G472.
[13] Preveden T, Veres B, Ruzic M, et al. Triglyceride-glucose index and hepatic steatosis index for the assessment of liver steatosis in HCV patients. Minerva Gastroenterol (Torino), 2023, 69(2):254-260.
[14] Fan H, Liu Z, Zhang P, et al. Characteristics and long-term mortality of patients with non-MAFLD hepatic steatosis. Hepatol Int, 2023, 17(3):615-625.
[15] Long MT, Noureddin M, Lim JK. AGA clinical practice update: diagnosis and management of nonalcoholic fatty liver disease in lean individuals: expert review. Gastroenterology, 2022, 163(3):764-774,e1.
[16] 包静文,朱宇莉,徐庆玥,等.超声声衰减成像评估代谢相关脂肪性肝病肝脂肪变程度的应用价值.中华超声影像学杂志, 2021, 30(10):868-873.
[17] 王丹,龙富立,连溯,等.超声声衰减成像对代谢相关性脂肪肝的临床诊断价值及影响因素分析.临床超声医学杂志, 2023, 25(1):8-12.
[18] Nagabhushana K, Wang Q, Han A. Pulse-echo technique to compensate for laminate membrane transmission loss in phantom-based ultrasonic attenuation coefficient measurements. J Ultrasound Med, 2023, 42(1):45-58.
[19] Han A, Zhang YN, Boehringer AS, et al. Inter-platform reproducibility of ultrasonic attenuation and backscatter coefficients in assessing NAFLD. Eur Radiol, 2019, 29(9):4699-4708.
[20] Pinnaduwage L, Ye C, Hanley AJ, et al. Changes over time in hepatic markers predict changes in insulin sensitivity, β-Cell function, and glycemia. J Clin Endocrinol Metab, 2018, 103(7):2651-2659.

超声声衰减系数联合血清ALT/AST比值评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究^*

Ultrasound attenuation coefficient and serumALT/AST ratio in evaluating liver steatosis in patients with nonalcoholic fatty liver disease

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