二维剪切波弹性成像对2型糖尿病合并非酒精性脂肪肝病患者肝纤维化的诊断价值  

Value of two-dimensional shear wave elastography in diagnosis of liver fibrosis in patients with type 2 diabetes mellitus and non-alcoholic fatty liver

作　　者：刘春影 许青 王飞[1] 高磊[1] LIU Chun-ying;XU Qing;WANG Fei;GAO Lei(Tianjin Medical University Chu Hsien-I Memorial Hospital,Tianjin Endocrinolology Institute,Tianjin Key Laboratory of Metabolic Diseases,NHC Key Laboratory of Hormones and Development,Tianjin 300134,China;The Ninth Medical Center,Chinese PLA General Hospital,Beijing 100101,China)

机构地区：[1]天津医科大学朱宪彝纪念医院,天津市内分泌研究所,天津市代谢性疾病重点实验室,国家卫生健康委激素与发育重点实验室,天津300134 [2]解放军总医院第九医学中心,北京100101

出　　处：《医疗卫生装备》2024年第9期73-77,共5页Chinese Medical Equipment Journal

基　　金：天津市医学重点学科(专科)建设项目(TJYXZ DXK-032A);天津医科大学朱宪彝纪念医院科研基金项目(ZXY-ZDSYS2021-5)。

摘　　要：目的:探讨二维剪切波弹性成像(two-dimensional shear wave elastography,2D-SWE)技术在2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)患者中诊断肝纤维化的应用价值。方法:选取2020年5月至2021年5月于某院确诊的100例T2DM合并NAFLD患者,依据NAFLD程度将患者分为轻度(38例)、中度(35例)、重度(27例)3组。对比3组患者的肝脏硬度测量(liver stiffness measurement,LSM)值;绘制ROC曲线,评价2D-SWE技术对T2DM合并NAFLD患者发生进展性肝纤维化的诊断效能。采用SPSS 26.0统计学软件进行数据分析。结果:3组患者LSM值比较,差异有统计学意义(P<0.001),轻度组与中度组、轻度组与重度组LSM值比较,差异有统计学意义(P<0.001),中度组与重度组LSM值比较,差异无统计学意义(P=0.065),LSM值随NAFLD程度的加重而升高。发生进展性肝纤维化的患者16例,非进展性肝纤维化的患者84例,进展性和非进展性肝纤维化患者LSM值的中位数分别为8.3、5.0 kPa,前者明显大于后者,差异有统计学意义(P<0.001)。ROC曲线显示,2D-SWE诊断T2DM合并中、重度NAFLD患者发生进展性肝纤维化的AUC为0.896(95%CI:0.819~0.974),当截断值为7.85 kPa时,其敏感度为92.3%,特异度为83.7%。结论:利用2D-SWE技术所测LSM值在不同程度NAFLD患者中定量检查结果存在差异,可辅助超声检查判断患者NAFLD的程度,且2D-SWE技术对T2DM合并NAFLD患者的进展性肝纤维化诊断效能良好。Objective To evaluate the value of two-dimensional shear wave elastography(2D-SWE)in the diagnosis of liver fibrosis in patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease(NAFLD).Methods A total of 100 patients with T2DM complicated with NAFLD from some hospital were selected and was divided into three groups based on the degree of NAFLD including a mild group(38 cases),a moderate group(35 cases)and a severe group(27 cases).The values of liver stiffness measurement(LSM)in different degrees of fatty liver of the three groups were compared;the receiver operating characteristic(ROC)curve was used to evaluate the efficacy of 2D-SWE technique in diagnosing progressive liver fibrosis in T2DM patients with NAFLD.SPSS 26.0 statistical software was used for data analysis.Results The three groups had significant differences in LSM value(P<0.001),and the differences of the LSM values between the mild and moderate groups and between the mild and severe groups were all statistically significant(P<0.001),while the moderate and severe groups had no obvious difference in LSM value(P=0.065),with the LSM value increasing with the aggravation of NAFLD.There were 16 patients with progressive hepatic fibrosis and 84 ones with non-progressive hepatic fibrosis,and the median LSM value of patients with progressive heaptic fibrosis(8.3 kPa)significantly higher than that of patients with non-progressive hepatic fibrosis(5.0 kPa)(P<0.001).The ROC curve showed that the area under the curve(AUC)of 2D-SWE for the diagnosis of progressive liver fibrosis in T2DM patients with moderate and severe fatty liver was 0.896[95%confidence interval(CI):0.819-0.974],and the diagnostic sensitivity and the specificity was 92.3%and 83.7%respectively when the optimal cut-off value was 7.85 kPa.Conclusion The quantitative results of the LSM values measured by 2D-SWE technology differ in patients with different degrees of NAFLD,which can be used for auxiliary diagnosis of the degree of NAFLD and behaves well in diagnosing

关 键 词：二维剪切波弹性成像 2型糖尿病 非酒精性脂肪肝病 LSM 进展性肝纤维化 

分 类 号：R445.1[医药卫生—影像医学与核医学] R587.1[医药卫生—诊断学] R575[医药卫生—临床医学]