实时组织弹性成像评估非酒精性脂肪性肝炎患者肝纤维化分期临床价值研究*

doi:10.3969/j.issn.1672-5069.2024.01.013

摘要/Abstract

摘要： 目的探讨采用实时组织弹性成像(RTE)技术检测评估非酒精性脂肪性肝炎(NASH)患者肝纤维化分期的价值。方法 2021年6月～2022年6月我院收治的159例非酒精性脂肪性肝病(NAFLD)患者【其中单纯性脂肪肝(SFL)89例、NASH 47例和肝硬化23例】和53例健康体检者,均接受彩色超声诊断仪RTE检测肝脏有关指标,NAFLD患者接受肝活检。应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)分析诊断效能。结果 LC组RTE指标相对应变值为(94.3±13.5),显著低于NASH患者【(105.2±20.6),P<0.05】或SFL患者【(115.1±9.8),P<0.05】或健康人【(121.3±17.1),P<0.05】,而蓝色面积百分比、复杂度、偏度、对比度和杂乱度分别为(25.9±4.3)%、(38.5±4.2)、(0.6±0.1)、(241.0±30.5)和(0.4±0.1),均显著高于NASH患者【分别为(21.2±4.1)%、(31.9±3.7)、(0.4±0.1)、(191.3±27.9)和(0.2±0.1),P<0.05】或SFL患者【分别为(16.2±1.9)%、(25.1±3.5)、(0.3±0.1)、(153.0±19.8)和(0.1±0.1),P<0.05】或健康人【分别为(9.2±1.5)%、(19.5±2.4)、(0.2±0.0)、(113.5±20.3)和(0.1±0.0),P<0.05】;在47例NASH患者中,病理学检查发现S0/S1期肝纤维化者16例,S2期19例和S3期12例;S3和S2期患者相对应变值分别为(101.2±7.9)和(106.7±10.3),显著低于S0/S1期患者【(112.5±9.8),P<0.05】,而S3期患者蓝色面积百分比、复杂度、偏度、对比度和杂乱度分别为(23.1±3.4)%、(34.6±3.7)、(0.4±0.1)、(202.5±23.7)和(0.2±0.0),显著大于S2期患者【分别为(19.8±2.5)%、(29.3±2.9)、(0.3±0.1)、(179.1±25.9)和(0.2±0.0),P<0.05】或S0/S1期患者【分别为(16.2±3.8)%、(25.9±3.5)、(0.3±0.1)、(152.8±21.1)和(0.1±0.1),P<0.05】;ROC曲线分析显示,综合RTE指标诊断NASH患者显著性和进展期肝纤维化的AUC为0.977,其灵敏度为84.2%,特异度为66.7%,准确性为77.4%。结论采用超声RTE指标诊断NASH患者显著性和进展期肝纤维化具有一定的临床价值,值得深入研究。

关键词: 非酒精性脂肪性肝炎, 肝纤维化, 实时组织弹性成像, 诊断

Abstract: Objective The aim of this study was to explore the diagnostic efficacy of real-time tissue elastography (RTE) in evaluating the liver fibrosis in patients with non-alcoholic steatohepatitis (NASH). Methods 159 patients with non-alcoholic fatty liver diseases (NAFLD), including simple fatty liver (SFL) in 89 cases, NASH in 47 cases and liver cirrhosis (LC) in 23 cases, and 53 healthy persons at physical examination were enrolled in our hospital between June 2021 and June 2022, and all underwent RTE examination. All patients with NAFLD received liver biopsies. The area under the receiver operating characteristic curve (AUROC) was applied to predict the diagnostic performance. Results The relative strain value in patients with LC was (94.3±13.5), significantly lower than [(105.2±20.6), P<0.05] in patients with NASH or [(115.1±9.8), P<0.05] in patients with SFL or [(121.3±17.1), P<0.05] in healthy control, but the percentage of blue area, complexity, measure skewness, contrast and clutter were(25.9±4.3)%, (38.5±4.2), (0.6±0.1), (241.0±30.5) and (0.4±0.1), all significantly higher than [(21.2±4.1)%, (31.9±3.7), (0.4±0.1), (191.3±27.9) and (0.2±0.1), P<0.05] in patients with NASH or [(16.2±1.9)%, (25.1±3.5), (0.3±0.1), (153.0±19.8) and (0.1±0.1), P<0.05] in patients with SFL or [(9.2±1.5)%, (19.5±2.4), (0.2±0.0), (113.5±20.3) and (0.1±0.0), P<0.05] in healthy persons; out the 47 patients with NASH, the histopathological examination showed liver fibrosis S0/S1 in 16 cases, S2 in 19 cases and S3 in 12 cases; the relative strain value in patients with S3 and with S2 were (101.2±7.9) and (106.7±10.3), significantly lower than [(112.5±9.8), P<0.05] in patients with S0/S1, while the percentage of blue area, complexity, measure skewness, contrast and clutter in patients with S3 were(23.1±3.4)%, (34.6±3.7), (0.4±0.1), (202.5±23.7) and (0.2±0.0), all significantly greater than [(19.8±2.5)%, (29.3±2.9), (0.3±0.1), (179.1±25.9) and (0.2±0.0), P<0.05] in patients with S2 or [(16.2±3.8)%, (25.9±3.5), (0.3±0.1), (152.8±21.1) and (0.1±0.1), respectively, P<0.05] in patients with S0/S1; the ROC analysis showed that the AUC was 0.977, with the sensitivity of 84.2%, the specificity of 66.7% and the accuracy of 77.4%, when the RTE parameters were synthetically applied to predict the significant and advanced liver fibrosis in patients with NASH. Conclusion The RTE parameters in deed has to some extent a diagnostic efficacy in predicting the significant and advanced liver fibrosis in patients with NASH, and needs further clinical investigation.

Key words: Non-alcoholic steatohepatitis, Liver fibrosis, Real-time tissue elastography, Diagnosis

张书琴, 王婷婷, 张艳红. 实时组织弹性成像评估非酒精性脂肪性肝炎患者肝纤维化分期临床价值研究^*[J]. 实用肝脏病杂志, 2024, 27(1): 48-51.

Zhang Shuqin, Wang Tingting, Zhang Yanhong. Significant and advanced liver fibrosis in patients with non-alcoholic steatohepatitis: What is the performance of real-time tissue elastography evaluation?[J]. Journal of Practical Hepatology, 2024, 27(1): 48-51.

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实时组织弹性成像评估非酒精性脂肪性肝炎患者肝纤维化分期临床价值研究^*

Significant and advanced liver fibrosis in patients with non-alcoholic steatohepatitis: What is the performance of real-time tissue elastography evaluation?

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