超声声衰减系数与受控衰减参数联合肝脏硬度检测诊断NAFLD患者NASH发生效能研究  

Prediction of nonalcoholic steatohepatitis by ultrasonic attenuation coefficient or controlled attenuation parameter and liver stiffness measurement combination in patients with nonalcoholic fatty liver diseases

作　　者：谢爱萍 赵景 蒋祁明 何秀波[1] Xie Aiping;Zhao Jing;Jiang Qiming(Department of Ultrasound,Fourth Hospital Affiliated to Hunan Normal University,Changsha 410006,Hunan Province,China)

机构地区：[1]湖南师范大学附属长沙医院/长沙第四医院超声医学科,长沙市410006

出　　处：《实用肝脏病杂志》2024年第5期705-708,共4页Journal of Practical Hepatology

基　　金：湖南省卫生健康委科研计划项目(编号:D202309026855)。

摘　　要：目的探讨超声声衰减系数(UAC)与受控衰减参数(CAP)联合肝脏硬度检测(LSM)诊断非酒精性脂肪性肝炎(NASH)的效能。方法2020年6月~2023年6月我科诊治的87例非酒精性脂肪性肝病(NAFLD)患者,均接受彩色多普勒超声诊断仪检测UAC,使用FibroTouch检测CAP和LSM,所有患者接受肝活检,经脂肪性肝病活动评分(NAS)诊断NASH。应用受试者工作特征曲线(ROC)分析指标诊断NASH的效能。结果经组织病理学检查,本组诊断SFL者61例,NASH者26例;NASH组UAC、CAP和LSM分别为(0.9±0.1)dB/cm·MHz、(327.4±30.6)dB/m和(11.6±1.6)kPa,均显著高于SFL组【分别为(0.6±0.1)dB/cm·MHz、(266.3±21.5)dB/m和(6.7±0.4)kPa,P<0.05】;分别以CAP为315.2 dB/m和LSM为10.3 kPa或UAC为0.9 dB/cm·MHz为截断点,前者诊断NASH的曲线下面积为0.9,其敏感性为84.0%,特异性为87.6%,显著优于UAC诊断(分别为0.8、80.0%和72.4%,P<0.05)。结论应用CAP联合LSM诊断NAFLD患者NASH发生具有很高的效能,可帮助临床进行初步筛查。Objective The aim of this study was to investigate prediction of nonalcoholic steatohepatitis(NASH)by ultrasonic attenuation coefficient(UAC)or controlled attenuation parameter(CAP)and liver stiffness measurement(LSM)combination in patients with nonalcoholic fatty liver diseases(NAFLD).Methods 87 patients with NAFLD were recruited in our hospital between June 2020 and June 2023,and all underwent liver biopsies and ultrasonography for UAC detection or Fibrotouch for CAP and LSM detection.Receiver operating characteristic(ROC)was applied to predict existence of NASH.Results Histopathological examination showed simple fatty liver(SFL)in 61 cases and NASH in 26 cases;the UAC,CAP and LSM in patients with NASH were(0.9±0.1)dB/cm·MHz,(327.4±30.6)dB/mand(11.6±1.6)kPa,all significantly greater than[(0.6±0.1)dB/cm·MHz,(266.3±21.5)dB/m and(6.7±0.4)kPa,respectively,P<0.05]in patients with SFL;the area under ROC(AUC)was 0.9,with sensitivity(Se)of 84.0%and specificity(Sp)of 87.6%,when CAP of 315.2 dB/m and LSM of 10.3 kPa were combined as cut-off-value(COV)in predicting existence of NASH,much superior to that by UAC(COV was 0.9 dB/cm·MHz,AUC was 0.8,Se was 80.0%and Sp was 72.4%,P<0.05).Conclusion Combination of CAP and LSM in predicting occurrence of NASH in patients with NAFLD has a satisfactory diagnostic performance,which might help to screen in clinical practice.

关 键 词：非酒精性脂肪性肝炎 超声声衰减系数 受控衰减参数 肝硬度检测 诊断 

分 类 号：R575.5[医药卫生—消化系统] R445.1[医药卫生—内科学]