FibroScan~实施受控衰减参数检测肝脂肪变的影响因素及应用价值分析  

Influential factors and clinical value of controlled attenuation parameters in the evaluation of hepatic steatosis using FibroScan~

作　　者：陈建能 陈爱萍 潘勤[2] 郭其裕 沈峰[2] 郑瑞丹 范建高[2] 

机构地区：[1]漳州正兴医院肝病中心,福建363000 [2]上海交通大学医学院附属新华医院消化内科

出　　处：《肝脏》2016年第10期805-809,共5页Chinese Hepatology

基　　金：中国肝炎防治基金会天晴肝病研究基金(TQGB2011018);福建省漳州市科技计划资助项目(Z04094)

摘　　要：目的探讨FibroScan实施受控衰减参数（controlled attenuation parameter,CAP）无创定量检测肝脂肪变的影响因素及应用价值。方法纳入非酒精性脂肪性肝病患者46例,慢性乙型肝炎并肝脂肪变患者31例。以肝活检为＂金标准＂评价肝脂肪含量,其中肝脂肪变分级S0：〈5%;S1：5%~33%;S2：34%~66%;S3：〉66%。使用FibroScan-502机型及M探头对所有研究对象进行CAP值测定。分析CAP值与肝脂肪含量、人体学指标及生化学指标的相关性。结果肝脂肪变处于S0、S1、S2、S3的患者分别有12例、29例、31例、5例。CAP值随着肝脂肪变分级增加而增大,各级肝脂肪变患者CAP值差异具有统计学意义（χ^2=36.990,P=0.000）,相邻两级间CAP值差异均具有统计学意义（均P〈0.05）;Spearman相关分析表明,CAP值与体质指数（BMI）（r=0.368,P=0.001）、腰围（r=0.298,P=0.008）、肝脂肪变分级（r=0.696,P=0.000）呈正相关,与年龄（r=-0.335,P=0.003）呈负相关。当控制了肝脂肪变分级后,偏相关分析显示,CAP值仍与BMI（r=0.242,P=0.035）、腰围（r=0.243,P=0.034）呈正相关,与年龄（r=-0.142,P=0.222）的相关关系消失;多元逐步回归分析显示,仅肝脂肪变分级是肝脏CAP值的独立影响因素;受试者工作特征曲线分析发现,CAP诊断肝脂肪变程度≥5%、≥34%、≥67%的曲线下面积分别为0.891（P=0.000）、0.862（P=0.000）、0.889（P=0.004）,最佳临界值分别为279、318、332 dB/m。结论 FibroScan实施CAP无创定量检测肝脂肪变具有较好的应用价值,肝脂肪变分级是肝脏CAP值的独立影响因素。Objective To investigate influential factors and clinical value of controlled attenuation parameters（CAP）in the measurement of hepatic steatosis using FibroScan.Methods Forty six patients with non-alcoholic fatty liver disease and 31 chronic hepatitis B patients with hepatic steatosis were enrolled in the study.Hepatic steatosis was graded by the liver lipids content pathologically：S0〈5%,S1：5%-33%,S2：34%-66%,S3〉66%.Measurement of CAP in all those cases carried out by FibroScan-502 and M probe,and its correlations with other factors,including hepatic steatosis grade,anthropometric parameters and biochemistry index,were also analyzed.Results Patients with hepatic steatosis were 12,29,31 and 5 in grade S0,S1,S2 and S3,respectively.The CAP value was positively correlated with hepatic steatosis grade,which was statistically significant different in each grade（χ^2=36.990,P=0.000）,as well as every adjacent two grades（P〈0.05）.Spearman correlation analysis showed that CAP value had a positive correlation with BMI（r=0.368,P=0.001）,waist circumference（r=0.298,P=0.008）and hepatic steatosis grade（r=0.696,P=0.000）,but a negative correlation with age（r=-0.335,P=0.003）.Setting hepatic steatosis grades as control variables,partial correlation analysis revealed that CAP value was still positively correlated with BMI（r=0.242,P=0.035）and waist circumference（r=0.243,P=0.034）,but showed no correlation with age（r=-0.142,P=0.222）.Stepwise multiple regression analysis showed that hepatic steatosis grade was the only independent influential factor for CAP value.In addition,the areas under the receiver operating characteristic curve（ROC）overall were 0.891（P=0.000）,0.862（P=0.000）,0.889（P=0.004）for steatosis≥ 5%,≥ 34% and≥ 67%,respectively,and the optimal cut-off values were 279,318 and 332 dB/m,respectively.Conclusion CAP of FibroScan~ had a satisfactory clinical value in quantitative evaluation of hepatic steatosis.Additionally,hepatic steatosis grade was an i

关 键 词：瞬时弹性记录仪 受控衰减参数 肝脂肪变 影响因素 

分 类 号：R575.5[医药卫生—消化系统]