多参数超声定量评估高风险脂肪性肝炎的临床价值  

Clinical value of multiparameteric quantitative ultrasound for assessing high-risk steatohepatitis

作　　者：李雪齐 程广文 乔晓慧 薛立云 黄翀 黄先觉 姚琪远 丁红 Li Xueqi;Cheng Guangwen;Qiao Xiaohui;Xue Liyun;Huang Chong;Huang Xianjue;Yao Qiyuan;Ding Hong(Department of Ultrasound,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Infectious Diseases,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of General Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China;National Clinical Research Center for Aging and Medicine,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院超声医学科,上海200040 [2]复旦大学附属华山医院感染科,上海200040 [3]复旦大学附属华山医院普外科,上海200040 [4]国家老年疾病临床医学研究中心,上海200040

出　　处：《中华肝脏病杂志》2024年第9期820-827,共8页Chinese Journal of Hepatology

基　　金：国家自然科学基金(81873897);上海市科技攻关计划(22Y11911500)。

摘　　要：目的探讨多参数定量超声组合的预测模型无创评估高风险脂肪性肝炎的临床价值。方法选取2021年6月至2022年9月于复旦大学附属华山医院就诊并进行肝活检的代谢相关脂肪性肝病(MAFLD)患者194例,所有患者肝活检前均行剪切波弹性成像(SWE)、剪切波频散成像(SWD)和衰减成像(ATI)检查。以病理肝脂肪变性、炎症活动度、纤维化评分系统(SAF)为标准,高风险脂肪性肝炎定义为在脂肪性肝炎患者中脂肪变性、肝细胞气球样变及肝脏小叶炎症三者的总活动评分≥4,且纤维化分期≥F2。二元logistic回归分析高风险脂肪性肝炎的影响因素,并依此使用R语言构建诊断高风险脂肪性肝炎的预测模型,DeLong检验进行组间曲线下面积比较。计量资料用t检验或秩和检验进行组间比较,计数资料用χ^(2)检验进行组间比较。结果高风险脂肪性肝炎患者46例(23.7%),定量超声参数包括弹性模量(OR=2.958,95%CI:1.889~4.883,P<0.001)、频散系数(OR=1.786,95%CI:1.424~2.292,P<0.001)和衰减系数(OR=42.642,95%CI:3.463~640.451,P=0.004);血清学指标空腹血糖(OR=1.196,95%CI:1.048~1.392,P=0.011)、丙氨酸转氨酶(OR=1.012,95%CI:1.006~1.019,P<0.001)、天冬氨酸转氨酶(OR=1.027,95%CI:1.014~1.042,P<0.001)、γ-谷氨酰转移酶(OR=1.008,95%CI:1.001~1.017,P=0.041)和高密度脂蛋白胆固醇(OR=0.087,95%CI:0.016~0.404,P=0.003)是其进展的影响因素。弹性模量、频散系数、衰减系数、多参数超声模型、血清学指标模型和超声结合血清学模型诊断高风险脂肪性肝炎的曲线下面积分别为0.764、0.758、0.634、0.786、0.773和0.825。DeLong检验结果显示超声结合血清学模型明显优于血清学指标模型和单独的弹性模量、频散系数、衰减系数(P值分别为0.024和0.027、0.038、<0.001)。结论多参数定量超声的组合有助于无创诊断高风险脂肪性肝炎,具有较大的临床意义。Objective To investigate the clinical value of multiparameteric quantitative ultrasound combined with a non-invasive prediction model for assessing high-risk steatohepatitis.Methods One hundred and ninety-four cases with metabolic-associated fatty liver disease(MAFLD)who underwent liver biopsy in Huashan Hospital,Fudan University,from June 2021 to September 2022 were selected.Shear wave elastography(SWE),shear wave dispersion(SWD)imaging,and attenuation imaging(ATI)examinations were conducted in all patients before biopsy.High-risk steatohepatitis was defined as a total activity score of≥4 in patients with steatohepatitis,hepatocellular ballooning,and liver lobular inflammation based on pathological hepatic steatosis,inflammatory activity,and fibrosis scoring system(SAF),and fibrosis stage≥F2.Binary logistic regression analysis was used to identify the factors influencing high-risk steatohepatitis.A predictive model for diagnosing high-risk steatohepatitis was constructed using R language.The DeLong test was used to compare the area under the curve between groups.Measurement data was compared between groups using the t-test or rank-sum test,and count data were compared between groups using theχ^(2) test.Results There were 46 cases(23.7%)with high-risk steatohepatitis.The quantitative ultrasound parameters included elastic modulus(OR=2.958,95%CI:1.889-4.883,P<0.001),dispersion coefficient(OR=1.786,95%CI:1.424-2.292,P<0.001)and attenuation coefficient(OR=42.642,95%CI:3.463-640.451,P=0.004).Serological indexes of fasting blood glucose(OR=1.196,95%CI:1.048-1.392,P=0.011),alanine aminotransferase(OR=1.012,95%CI:1.006-1.019,P<0.001),aspartate aminotransferase(OR=1.027,95%CI:1.014-1.042,P<0.001),γ-glutamyl transferase(OR=1.008,95%CI:1.001-1.017,P=0.041)and HDL cholesterol(OR=0.087,95%CI:0.016-0.404,P=0.003)were the factors influencing its progression.The AUCs of elastic modulus,dispersion coefficient,attenuation coefficient,multiparametric ultrasound model,serological index model,and ultrasound combined with serol

关 键 词：诊断 多参数定量超声 高风险脂肪性肝炎 预测模型 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575.5[医药卫生—诊断学]