超声瞬时弹性成像检测受控衰减参数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.1672-5069.2024.02.008

摘要/Abstract

摘要： 目的分析应用超声瞬时弹性成像检测的受控衰减参数(CAP)评估非酒精性脂肪性肝病(NAFLD)患者肝脂肪变程度的价值。方法 2020年5月～2022年5月我院诊治的NAFLD患者78例, 均接受肝脏超声检查和超声瞬时弹性成像检查, 绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估CAP诊断NAFLD患者肝脂肪变程度的效能。结果肝脏超声检查结果显示, 78例NAFLD患者中包括轻度肝脂肪变41例、中度肝脂肪变23例和重度肝脂肪变14例;重度肝脂肪变患者血清ALT和AST水平分别为(77.2±14.9) U/L和(59.1±11.7)U/L, 显著高于中度肝脂肪变患者【分别为(40.1±8.3)U/L和(35.9±6.2)U/L, P<0.05】或轻度肝脂肪变患者【分别为(26.7±5.5)U/L和(23.3±4.8)U/L, P<0.05】;重度肝脂肪变患者血清TG水平和CAP分别为(3.5±0.7)mmol/L和(317.7±27.6)dB/m, 显著高于轻度肝脂肪变患者【分别为(1.6±0.6)mmol/L和(259.9±27.5)dB/m, P<0.05】或中度肝脂肪变患者【分别为(2.7±0.6)mmol/L和(292.1±30.7)dB/m, P<0.05】, 而血清HDL-C水平为(0.8±0.4)mmol/L, 显著低于轻度肝脂肪变患者【(1.3±0.3)mmol/L, P<0.05】或中度肝脂肪变患者【(1.1±0.3)mmol/L, P<0.05】; 以CAP＞285.4dB/m为截断点, 诊断NAFLD患者中度肝脂肪变, 以CAP＞309.1dB/m为截断点, 诊断NAFLD患者重度肝脂肪变, 结果发现轻度肝脂肪变39例, 中度肝脂肪变22例, 重度肝脂肪变17例, 其AUC、敏感度和特异度分别为0.783(95% CI:0.669～0.896)、78.3%和75.6%, 和0.696(95% CI:0.515～0.876)、78.6%和69.6%(P<0.05)。结论应用CAP诊断NAFLD患者肝脂肪变程度可能比超声检查更准确, 有很大的临床应用价值。

关键词: 非酒精性脂肪性肝病, 肝脂肪, 超声瞬时弹性成像, 受控衰减参数, 诊断

Abstract: Objective The aim of this study was to investigate the evaluation of hepatic steatosis by controlled attenuation parameter (CAP) of ultrasonic transient elastography in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 78 patients with NAFLD were enrolled in our hospital between May 2020 and May 2022, and they all received liver ultrasonography and ultrasonic transient elastography for CAP. The receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was calculated to evaluate the efficacy of CAP in predicting the degree of hepatic steatosis in patients with NAFLD. Results The liver ultrasonography showed that out of the 78 patients with NAFLD in our series, there were mild hepatic steatosis in 41 cases, moderate hepatic steatosis in 23 cases and severe hepatic steatosis in 14 cases; serum ALT and AST levels in patients with severe liver steatosis were (77.2±14.9) U/L and (59.1±11.7)U/L, significantly higher than in patients with moderate or in patients with mild liver steatosis; serum triglyceride level and the CAP in patients with severe liver steatosis were (3.5±0.7)mmol/L and (317.7±27.6)dB/m, both significantly higher than in patients with mild or in patients with moderate, while serum high-density lipoprotein cholesterol level was (0.8±0.4)mmol/L, much lower than in patients with mild or in patients with moderate liver steatosis; with the CAP>280.4dB/m as the cut-off value for the diagnosis of moderate hepatic steatosis in patients with NAFLD, the AUC, sensitivity (Se) and specificity (Sp) were 0.783 (95%CI: 0.669-0.896), 78.3% and 75.6%, and with the CAP>309.1 dB/m as the cut-off value for the diagnosis of severe hepatic steatosis, the AUC was 0.696 (95% CI: 0.515-0.876), with the Se of 78.6% and the Sp of 69.6% (P<0.05). Conclusion The application of CAP obtained by ultrasonic transient elastography might help assess more accurately the severity of liver steatosis in patients with NAFLD.

Key words: Nonalcoholic fatty liver diseases, Hepatic steatosis, Ultrasonic transient elastography, Controlled attenuation parameter, Diagnosis

郭萌, 郭琦, 张峰. 超声瞬时弹性成像检测受控衰减参数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, 2024, 27(2): 189-192.

Guo Meng, Guo Qi, Zhang Feng. Evaluation of hepatic steatosis by controlled attenuation parameter of ultrasonic transient elastography in patients with nonalcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2024, 27(2): 189-192.

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超声瞬时弹性成像检测受控衰减参数评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究^*

Evaluation of hepatic steatosis by controlled attenuation parameter of ultrasonic transient elastography in patients with nonalcoholic fatty liver diseases

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