FibroScan检测和CT肝脾比值诊断非酒精性脂肪性肝病肝内脂肪分级价值研究*

doi:10.3969/j.issn.1672-5069.2026.03.010

摘要/Abstract

摘要： 目的分析FibroScan检测联合电子计算机断层扫描(CT)检测肝脾CT值 (CT_L/S) 比值诊断非酒精性脂肪性肝病(NAFLD)患者肝内脂肪变程度的价值。方法 2023年1月～2025年6月我院诊治的NAFLD患者106例,均行肝活检组织病理学检查,行CT检查测量肝脏和脾脏CT值,计算CT_L/S比值,使用FibroScan行肝脏硬度检测(LSM)和受控衰减参数(CAP)检测,采用多元线性回归分析评估CAP和CT_L/S比值与NAFLD患者肝脂肪变性程度的关联性,应用受试者工作特征(ROC)曲线线性分析指标诊断NAFLD患者重度肝脂肪变性的效能。结果肝组织学检查诊断轻度肝脂肪变32例,中度39例,重度35例;重度组体质指数、腰臀比、LSM和CAP分别为(29.3±2.1)kg/m²、(1.3±0.4)、(10.1±1.4)kPa和(327.6±32.0)dB/m,均显著高于中度组【分别为(26.0±2.2)kg/m²、(1.1±0.2)、(8.4±1.2)kPa和(288.7±27.6)dB/m,P<0.05】或轻度组【分别为(24.7±2.1)kg/m²、(0.9±0.1)、(7.5±1.3)kPa和(265.8±25.9)dB/m,P<0.05】,而CT_L/S比值为(0.5±0.1),显著低于中度组【(0.6±0.1),P<0.05】或轻度组【(0.7±0.1),P<0.05】;采用多元线性回归分析发现NAFLD患者肝脂肪变性程度与CAP呈正向关联(β=0.366,95%CI 0.148～0.687,P=0.006),与CT_L/S比值呈负向关联(β=-0.235,95%CI -0.101～0.393,P=0.015);ROC曲线分析显示,CAP联合CT_L/S比值诊断NAFLD患者重度肝脂肪变性的AUC为0.880,95% CI为0.809～0.950,其敏感性为80.0%,特异性为74.6%。结论应用CT_L/S比值与CAP联合诊断NAFLD患者肝脂肪变性程度具有较大的临床价值,可帮助临床筛查、指导临床干预决策。

关键词: 非酒精性脂肪性肝病, 肝脂肪变性, FibroScan, 受控衰减参数, 肝脾CT比值, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic efficacy of FibroScan and liver-spleen CT (CT_L/S) ratio combination in predicting hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods 106 patients with NAFLD were enrolled in our hospital between January 2023 and June 2025, and they all received liver biopsy for pathological examination, FibroScan for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), and CT scan for CT_L/S ratio. Multivariate linear regression analysis was applied to evaluate the correlation between FibroScan parameters, CT_L/S ratio and hepatic steatosis in patients with NAFLD. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic performance of FibroScan parameters and CT_L/S ratio in predicting severe hepatic steatosis. Results Liver histo-pathological examination found mild hepatic steatosis in 32 cases, moderate in 39 cases and severe in 35 cases; body mass index, waist-to-hip ratio, LSM and CAP in patients with severe liver steatosis were (29.3±2.1)kg/m², (1.3±0.4), (10.1±1.4)kPa and (327.6±32.0)dB/m, all significantly higher than [(26.0±2.2)kg/m², (1.1±0.2), (8.4±1.2)kPa and (288.7±27.6)dB/m, respectively, P<0.05] in those with moderate liver steatosis or [(24.7±2.1)kg/m², (0.9±0.1), (7.5±1.3)kPa and (265.8±25.9)dB/m, respectively, P<0.05] in those with mild liver steatosis, while CT_L/S ratio was (0.5±0.1), significantly lower than [(0.6±0.1), P<0.05] in those with moderate or [(0.7±0.1), P<0.05] in those with mild liver steatosis; multivariate linear regression analysis found CAP was positively correlated to(β=0.366, 95%CI 0.148-0.687, P=0.006), while CT_L/S ratio was negatively correlated to liver steatosis(β=-0.235, 95%CI -0.101-0.393, P=0.015); ROC analysis showed that the AUC was 0.880 (95% CI:0.809-0.950), with sensitivity of 80.0% and specificity of 74.6%, when CAP was combined with CT_L/S ratio in predicting severe liver steatosis in patients with NAFLD. Conclusion CT_L/S ratio and CAP combination is helpful in screening liver steatosis in patients with NAFLD, which might guide clinicians take appropriate measures for intervention.

Key words: Nonalcoholic fatty liver disease, Hepatic steatosis, FibroScan, Liver-spleen CT ratio, Controlled attenuation parameter, Diagnosis

曾浩, 李兵, 雷婷, 李顺华, 李孜. FibroScan检测和CT肝脾比值诊断非酒精性脂肪性肝病肝内脂肪分级价值研究^*[J]. 实用肝脏病杂志, 2026, 29(3): 357-360.

Zeng Hao, Li Bing, Lei Ting, et al. Diagnostic efficacy of FibroScan and liver-spleen CT ratio combination in predicting hepatic steatosis in patients with nonalcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2026, 29(3): 357-360.

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FibroScan检测和CT肝脾比值诊断非酒精性脂肪性肝病肝内脂肪分级价值研究^*

Diagnostic efficacy of FibroScan and liver-spleen CT ratio combination in predicting hepatic steatosis in patients with nonalcoholic fatty liver disease

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