肝脏脂肪含量对超声瞬时弹性成像肝纤维化诊断效能的影响  

Influence of Hepatic Fat Fraction on Staging of Hepatic Fibrosis by Ultrasound Transient Elastography

作　　者：彭静[1] 陈志远[1] 周懂晶[1] 杨逸铭 欧阳舒曼 刘玉品[1] PENG Jing;CHEN Zhiyuan;ZHOU Dongjing;YANG Yiming;OUYANG Shuman;LIU Yupin(Department of Radiology,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第二临床医学院影像科,广东广州510120

出　　处：《中国医学影像学杂志》2022年第8期797-802,808,共7页Chinese Journal of Medical Imaging

基　　金：广东省中医院中医药科学技术专项(YN2019QL09);广东省中医药局面上项目(20202072);东南大学横向课题(2020KT1000)。

摘　　要：目的 探讨肝脏脂肪含量对超声瞬时弹性成像(TE)肝纤维化分级诊断效能的影响。资料与方法 回顾性分析2017年1月—2020年7月在广州中医药大学第二临床医学院行肝脏穿刺的58例单纯慢性乙型肝炎(CHB)和58例CHB合并非酒精性脂肪肝(NAFLD)的影像学及病理资料,使用受试者工作特征曲线评估MRI质子密度脂肪分数(PDFF)和TE受控衰减参数(CAP)对肝脏脂肪含量的诊断效能,并使用Youden指数确定最佳截断值。以肝脏穿刺病理结果为“金标准”,探讨PDFF及CAP诊断的肝脏脂肪含量对TE肝脏硬度测量(LSM)诊断肝纤维化准确率的影响。结果 PDFF和CAP均能有效区分无-轻度与中-重度NAFLD,受试者工作特征曲线下面积分别为0.963、0.878,且PDFF优于CAP(Z=2.340,P=0.019);在经肝穿刺病理及PDFF诊断的中-重度NAFLD中,LSM对肝纤维化分级的诊断准确率明显低于无-轻度NAFLD(χ^(2)=1.279,P=0.042;χ^(2)=5.094,P=0.024)。PDFF区分无-轻度NAFLD与中-重度NAFLD的截断值是8.28,在PDFF>8.28的CHB患者中适当提高LSM分级阈值,能有效提升其诊断准确率(χ^(2)=9.402,P=0.002)。结论 中-重度脂肪肝会影响LSM在CHB患者肝纤维化分级中的诊断效能;当PDFF提示合并中-重度NAFLD时,适当提高LSM的诊断阈值可以改善其诊断准确率,有助于评估临床病情及制订治疗决策。Purpose To explore the influence of hepatic fat fraction on staging of hepatic fibrosis by ultrasound transient elastography(TE). Materials and Methods The radiological and pathological data of 58 chronic hepatitis B(CHB) patients and 58 CHB patients concomitant with non-alcoholic fatty liver(NAFLD) who underwent liver biopsy in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to July 2020 were retrospectively analyzed. MRI proton density fat fraction(PDFF) and controlled attenuation parameter(CAP) obtained from TE were used to identify liver fat fraction. Receiver operating characteristic(ROC) curve was used to assess their diagnostic efficacy and Youden index was used to determine their optimal cut-off values. Diagnostic accuracy of liver stiffness measurement(LSM, obtained by TE) for staging of liver fibrosis may be affected by hepatic steatosis(diagnosed by PDFF and CAP), whose influence was explored and examined using liver biopsy as the gold standard. Results Both PDFF and CAP had excellent diagnostic performance in differentiating no to mild NAFLD from moderate to severe NAFLD. The area under ROC curve of PDFF and CAP were 0.963and 0.878, respectively, and PDFF was better than CAP(Z=2.340, P=0.019). In patients with moderate to severe NAFLD diagnosed by liver biopsy and PDFF, the diagnostic accuracy of LSM for hepatic fibrosis staging was significantly lower than that with no to mild NAFLD(χ^(2)=1.279, P=0.042;χ^(2)=5.094, P=0.024, respectively). For CHB patients with PDFF>8.28, the diagnostic accuracy of LSM could be improved by elevating cut-off threshold(χ^(2)=9.402, P=0.002). Conclusion Moderate to severe NAFLD can affect the diagnostic performance of LSM in hepatic fibrosis staging in CHB patients. In those patients with moderate to severe NAFLD diagnosed by PDFF, a higher cut-off threshold of LSM can improve its diagnostic accuracy in hepatic fibrosis staging, which may be helpful for disease assessment and decision-making.

关 键 词：肝炎 乙型 肝纤维化 非酒精性脂肪肝 弹性瞬时成像 磁共振质子密度脂肪分数 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]