超声多定量参数组合评估高风险代谢相关性脂肪性肝炎患者临床应用研究*

doi:10.3969/j.issn.1672-5069.2025.06.013

摘要/Abstract

摘要： 目的探讨超声多定量参数组合评估高风险代谢相关性脂肪性肝炎(hrMASH)的临床价值。方法 2021年3月～2024年3月我院收治的MASH患者116例,均接受肝活检和超声剪切波弹性成像(SWE)、剪切波频散成像(SWD)和衰减成像(ATI)检测肝脏弹性模量、频散系数和衰减系数。绘制受试者工作特征曲线(ROC)评估诊断效能。结果在本组116例MASH患者中,经肝组织病理学检查诊断为hrMASH者49例(42.2%),非hrMASH者67例(57.8%);hrMASH患者血清总胆固醇和低密度脂蛋白胆固醇水平为(6.5±1.5)mmol/L和(3.9±0.9)mmol/L,显著高于非hrMASH患者【分别为(5.8±1.1)mmol/L和(3.1±0.7)mmol/L,P＜0.05】;hrMASH患者血清ALT和AST水平分别为(60.1±6.8)U/L和(44.6±4.7)U/L,显著高于非hrMASH患者【分别为(35.5±4.7)U/L和(33.4±3.4)U/L,P＜0.05】;hrMASH患者肝脏弹性模量、频散系数和衰减系数分别为(4.8±0.9)kPa、(12.1±2.0)m·s^-1·kHz^-1和(1.1±0.4)dB·cm^-1·MHz^-1,均显著大于非hrMASH患者【分别为(4.2±0.5)kPa、(10.4±1.7)m·s^-1·kHz^-1和(0.8±0.1)dB·cm^-1·MHz^-1,P＜0.05】;ROC曲线分析显示,超声多定量参数组合诊断hrMASH的AUC为0.858 (95%CI:0.790～0.927),其灵敏度为74.6%,特异度为89.8%。结论采用超声多定量参数组合判断hrMASH有较高的临床应用价值,值得扩大观察。

Abstract: Objective The aim of this study was to investigate the application of multiparametric ultrasound (US) in the assessment of patients with high-risk metabolic associated steatohepatitis (hrMASH). Methods A total of 116 patients with MASH were recruited in our hospital between March 2021 and March 2024, and all underwent liber biopsies and ultrasonography for shear wave elastography (SWE), shear wave dispersion imaging (SWD) and attenuation imaging (ATI) for measurement of liver elasticity modulus, dispersion coefficient and attenuation coefficient. Receiver operating characteristic (ROC) curve was drawn to assess the diagnostic efficacy of the multi-US quantitative parameter combination for hrMASH. Results Of the 116 patients with MASH, liver histo-pathological examination showed that hrMASH in 49 cases (42.2%) and non-hrMASH in 67 cases (57.8%); serum total cholesterol and low-density lipoprotein cholesterol levels in patients with hrMASH were(6.5±1.5)mmol/L and (3.9±0.9)mmol/L, both significantly higher than [(5.8±1.1)mmol/L and (3.1±0.7)mmol/L, respectively, P＜0.05] in those with non-hrMASH; serum alanine aminotransferase and aspartate aminotransferase levels in patients with hrMASH were (60.1±6.8)U/L and (44.6±4.7)U/L, both significantly higher than [(35.5±4.7)U/L and (33.4±3.4)U/L, respectively, P＜0.05] in those with non-hrMASH; liver elastic modulus, frequency dispersion coefficient and attenuation coefficient in patients with hrMASH were (4.8±0.9)kPa, (12.1±2.0)m·s^-1·kHz^-1 and (1.1±0.4)dB·cm^-1·MHz^-1, all much higher than [(4.2±0.5)kPa, (10.4±1.7)m·s^-1·kHz^-1 and (0.8±0.1)dB·cm^-1·MHz^-1, respectively, P＜0.05] in those with non-hrMASH; ROC analysis showed that the AUC was 0.858 (95%CI:0.790-0.927), with sensitivity of 74.6% and specificity of 89.8%, when combination of the three ultrasound parameters was applied for prediction of hrMASH. Conclusion Multiparametric US could help predict hrMASH in specific population, which warrants further clinical investigation.

Key words: Metabolic associated steatohepatitis, High-risk, Elasticity modulus, Dispersion coefficient, Attenuation coefficient, Diagnosis

王海玉, 张美喜, 张志博, 王倩, 刘翠翠. 超声多定量参数组合评估高风险代谢相关性脂肪性肝炎患者临床应用研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 850-853.

Wang Haiyu, Zhang Meixi, Zhang Zhibo, et al. Application of multiparametric ultrasound in the assessment of patients with high-risk metabolic associated steatohepatitis[J]. Journal of Practical Hepatology, 2025, 28(6): 850-853.

参考文献

[1] Younossi ZM, Golabi P, Paik J,et al. Prevalence of metabolic dysfunction-associated steatotic liver disease in the Middle East and North Africa. Liver Int, 2024,44(4):1061-1070.
[2] Huang J, Xue W, Wang M,et al. MAFLD criteria may overlook a subtype of patient with steatohepatitis and significant fibrosis. Diabetes Metab Syndr Obes, 2021,14:3417-3425.
[3] Yin JY, Yang TY, Yang BQ, et al. FibroScan-aspartate transaminase: a superior non-invasive model for diagnosing high-risk metabolic dysfunction-associated steatohepatitis. World J Gastroenterol, 2024,30(18):2440-2453.
[4] Kong W, Tang Y, Liu L,et al. Stratifying non-alcoholic steatohepatitis with the non-invasive ultrasound markers shear wave dispersion slope and shear wave velocity: an animal study. Ultrasound Med Biol, 2022,48(12):2442-2448.
[5] Basavarajappa L, Baek J, Reddy S, et al. Multiparametric ultrasound imaging for the assessment of normal versus steatotic livers. Sci Rep, 2021,11(1):2655.
[6] 中华医学会肝病学分会.代谢相关(非酒精性)脂肪性肝病防治指南(2024年版).实用肝脏病杂志,2024,27(4): 494-510.
[7] 王永康,魏诗雨,刘昌,等. 脂肪性肝病新定义:从非酒精性脂肪性肝病到代谢功能障碍相关脂肪性肝病. 中华消化外科杂志,2023,22(S1):117-121.
[8] 陈凯,居峰. 多烯磷脂酰胆碱联合扶正化瘀片治疗非酒精性脂肪性肝病患者肝脏超声脂肪变性评分变化. 实用肝脏病杂志,2022,25(2):219-222.
[9] Tada T, Nishimura T, Yoshida M,et al. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: new trends and role of ultrasonography. J Med Ultrason (2001), 2020,47(4):511-520.
[10] Sugimoto K, Moriyasu F, Oshiro H, et al. The role of multiparametric US of the liver for the evaluation of nonalcoholic steatohepatitis. Radiology, 2020,296(3):532-540.
[11] Wang K, Yu D, Li G, et al. Comparison of the diagnostic performance of shear wave elastography with shear wave dispersion for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. Eur J Radiol, 2022,154:110459.
[12] Cetiner M, Schiepek F, Finkelberg I, et al. Validation of attenuation imaging coefficient, shear wave elastography, and dispersion as emerging tools for non-invasive evaluation of liver tissue in children. Front Pediatr, 2023,11:1020690.
[13] 李雪齐,程广文,乔晓慧,等. 多参数超声定量评估高风险脂肪性肝炎的临床价值. 中华肝脏病杂志,2024,32(9):820-827.
[14] Younossi ZM, Mangla KK, Berentzen TL, et al. Liver histology is associated with long-term clinical outcomes in patients with metabolic dysfunction-associated steatohepatitis. Hepatol Commun, 2024,8(6):e0423.
[15] Smith AK, Ropella GEP, McGill MR, et al. Contrasting model mechanisms of alanine aminotransferase (ALT) release from damaged and necrotic hepatocytes as an example of general biomarker mechanisms. PLoS Comput Biol, 2020, 16(6):e1007622.
[16] Stadler JT, Marsche G. Obesity-related changes in high-density lipoprotein metabolism and function. Int J Mol Sci, 2020,21(23):8985.
[17] Kim Y, Hwang J, Bae SH, et al. Clinical feasibility of shear wave dispersion slope for noninvasive diagnosis of nonalcoholic steatohepatitis in patients with morbid obesity: preliminary results using US shear wave elastography. Ultrasound Q, 2022,38(2):149-154.
[18] Ferraioli G, Barr RG. Ultrasound liver elastography beyond liver fibrosis assessment. World J Gastroenterol, 2020,26(24):3413-3420.
[19] Garcovich M, Paratore M, Riccardi L,et al. Correlation between a new point-shear wave elastography device (X+pSWE) with liver histology and 2D-SWE (SSI) for liverstiffness quantification in chronic liver disease. Diagnostics (Basel), 2023,13(10):1743.
[20] Sugimoto K, Lee DH, Lee JY, et al. Multiparametric US for identifying patients with high-risk NASH: a derivation and validation study. Radiology, 2021,301(3):625-634.

超声多定量参数组合评估高风险代谢相关性脂肪性肝炎患者临床应用研究^*

Application of multiparametric ultrasound in the assessment of patients with high-risk metabolic associated steatohepatitis

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