超声衰减参数成像评估超重及肥胖患者肝脏脂肪变性价值研究  

Utility of Ultrasound-Guided Attenuation Parameter for Assessment of Hepatic Steatosis in Overweight and Obese Patients

作　　者：蔡韦雯 余进洪[1] 余慧珍 杨华武[3] 文宏 周鸿[2] 周洋[2] Cai Weiwen;Yu Jinhong;Yu Huizhen;Yang Huawu;Wen Hong;Zhou Hong;Zhou Yang(Department of Ultrasound,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 600037,China;Department of Ultrasound,The Third People's Hospital of Chengdu,Chengdu 610031,China;Department of General Surgery,The Third People's Hospital of Chengdu,Chengdu 610031,China)

机构地区：[1]川北医学院附属医院超声科,四川省南充市600037 [2]成都市第三人民医院超声科,成都市610031 [3]成都市第三人民医院普外科,成都市610031

出　　处：《中国超声医学杂志》2025年第2期165-169,共5页Chinese Journal of Ultrasound in Medicine

基　　金：四川省区域联合创新重点项目(No.2024YFHZ0078);国家自然科学基金面上项目(No.81971636)。

摘　　要：目的探讨超声衰减参数(UGAP)成像技术在超重及肥胖患者代谢相关脂肪性肝病(MASLD)脂肪变性程度中的诊断效能。方法选取减重手术患者119例,收集患者临床资料,并于入院2 d内行肝脏UGAP检查。患者均获得肝组织进行病理分级诊断。采用Spearman相关分析UGAP值与临床参数、病理的相关性,多元线性回归确定UGAP值的独立影响因素,受试者工作特征(ROC)曲线评估UGAP诊断脂肪变性程度的效能,Kappa检验评估UGAP与病理分级的一致性。结果病理诊断无、轻、中、重度脂肪变性分别为28例、53例、23例、15例。UGAP值与病理结果呈显著相关(r=0.812,P<0.001),与BMI值呈中等相关,与TG、LDL-C、ALT、AST呈弱相关,与HDL-C呈负弱相关;BMI、TG、ALT是UGAP值的独立影响因素;UGAP诊断肝脏轻、中、重度脂肪变性的最佳截断值分别为0.65、0.71、0.79,对应的AUC为0.932、0.929、0.906;UGAP与病理分级的一致性良好(Kappa值为0.702,P<0.001)。结论UGAP对超重及肥胖患者MASLD脂肪变性程度具有较好的诊断效能,可用于患者肝脏脂肪变性程度的无创性评估。Objective To investigate the diagnostic efficacy of ultrasound-guided attenuation parameter(UGAP)in the degree of hepatic steatosis in overweight and obese patients with metabolic dysfunction-associated steatotic liver disease(MASLD).Methods A total of 119 patients undergoing bariatric surgery were selected.The clinical data of the patients were collected,and the liver UGAP examination was performed within 2 days after admission.The pathological grading diagnosis of hepatic steatosis was obtained in all patients.Multiple linear regression was used to determine the independent influencing factors of UGAP value.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of UGAP in the diagnosis of steatosis,and Kappa test was used to evaluate the consistency between UGAP and pathological grade.Results The pathological diagnosis of non-fatty liver,mild,moderate and severe steatosis were 28,53,23 and 15 cases,respectively.UGAP was significantly correlated with pathological results(r=0.812,P<0.001),moderately correlated with BMI,weakly correlated with TG,LDL-C,ALT,AST,and negatively correlated with HDL-C.BMI,TG and ALT were independent influencing factors of UGAP value.The best cut-off values of UGAP in the diagnosis of mild,moderate and severe liver steatosis were 0.65,0.71 and 0.79,respectively,and the corresponding AUC values were 0.932,0.929 and 0.906.The consistency between UGAP and pathological grade was good(Kappa value was 0.702,P<0.001).Conclusions UGAP has a good diagnostic efficiency in the non-invasive assessment of liver steatosis in overweight and obese patients.

关 键 词：超声衰减参数 代谢相关脂肪性肝病 超重及肥胖患者 肝脏脂肪变性 

分 类 号：R575.5[医药卫生—消化系统] R445.1[医药卫生—内科学] R589.2[医药卫生—临床医学]