中老年非酒精性脂肪肝患者肝脏声像图特征及其与血脂的相关性  

Correlation between liver sonographic features and blood lipids in middle-aged and elderly patients with nonalcoholic fatty liver disease

作　　者：段锐 刘明春[1] 王瑜[1] 祝凤翠 季春艳 向玲 DUAN Rui;LIU Mingchun;WANG Yu;ZHU Fengcui;JI Chunyan;XIANG Ling(Department of Ultrasound,Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine,Panzhihua 617000,Sichuan,China)

机构地区：[1]攀枝花市中西医结合医院超声科,四川攀枝花617000

出　　处：《西部医学》2023年第2期272-276,共5页Medical Journal of West China

基　　金：四川省国际医学交流促进会麻醉医学专项课题(L2020509017)。

摘　　要：目的探讨中老年非酒精性脂肪肝患者肝脏声像图特征并分析声像图特征与血脂的相关性。方法选取2019年7月~2021年7月收治的120例中老年非酒精性脂肪肝病(NAFLD)患者为研究对象,参照血脂异常指南分为对照组(n=28,血脂正常)和观察组(n=92,血脂异常),比较两组肝脏超声声像图特征,并基于Logistic回归建立超声声像图特征诊断模型,获得模型方程式,采用Pearson相关系数分析声像图特征与血脂之间的相关性。结果两组患者肝脏大小形态、远处回声衰减、肝内管道结构及彩色血流信号差异均有统计学意义(P<0.05)。基于logistics回归获得模型方程式:Log(p)=0.938+1.725*A1-1.549*A2+1.263*A3+1.371*A4(A1=肝脏增大、肝缘角变钝,A2=回声衰减,A3=肝静脉变细不清,A4=彩色血流信号减少或无明显显示)。模型预测中老年NAFLD患者血脂异常的AUC为0.925,95%CI为0.862~0.965,约登指数为0.723,临界值为0.281,敏感度、特异度为90.22%、82.14%。将92例血脂异常中老年NAFLD患者肝脏声像图特征代入预测模型,该超声评分与甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)呈正相关(P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈负相关(P<0.05)。结论中老年NAFLD患者血脂与肝脏声像图特征密切相关,通过建立超声诊断模型可以获得血脂异常中老年NAFLD患者量化标准,提高诊断准确性,可为患者提供后续诊疗依据。Objective To analyze the liver sonographic features of middle-aged and elderly patients with nonalcoholic fatty liver disease(NAFLD),and explore the correlation between these sonographic features and blood lipids.Methods 120 middle-aged and elderly patients with NAFLD admitted to the hospital from July 2019 to July 2021 were selected as the research subjects.They were divided into control group(n=28,normal blood lipids)and observation group(n=92,dyslipidemia)according to the dyslipidemia guidelines.Liver sonographic features of the two groups were compared,and a diagnostic model was established based on these features after logistic regression analysis.Pearson correlation coefficient was used to analyze the relationship between sonographic features and blood lipids.Results There were statistically significant differences in liver size and shape,distant echo attenuation,intrahepatic duct structure and color blood flow signal between the two groups(P<0.05).The model equation obtained based on logistic regression analysis was as follows:Log(p)=0.938+1.725*A1-1.549*A2+1.263*A3+1.371*A4(A1=liver enlargement,blunt liver surface angle,A2=echo attenuation,A3=thin and unclear hepatic veins,and A4=reduced or not obvious color flow signal).The AUC of this model to predict dyslipidemia in middle-aged and elderly patients with NAFLD was 0.925(95%CI:0.862-0.965).When the Youden index was 0.723 and the critical value was 0.281,the sensitivity and specificity of this model were 90.22%and 82.14%.The ultrasound scores were positively correlated with triglycerides(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)(P<0.05),and negatively correlated with high-density lipoprotein cholesterol(HDL-C)(P<0.05).Conclusion Blood lipids in middle-aged and elderly patients with NAFLD are closely related to liver sonographic features.A quantitative standard of dyslipidemia in middle-aged and elderly patients with NAFLD can be obtained by establishing a diagnostic model,thereby improving the diagnostic accuracy,and providi

关 键 词：非酒精性脂肪肝 中老年 声像图特征 血脂 相关性 

分 类 号：R575.5[医药卫生—消化系统]