非酒精性脂肪性肝病的瞬时弹性成像技术和声辐射力脉冲成像技术的定量评价

doi:10.3969/j.issn.1004-583X.2021.06.011

临床荟萃 ›› 2021, Vol. 36 ›› Issue (6): 535-539.doi: 10.3969/j.issn.1004-583X.2021.06.011

非酒精性脂肪性肝病的瞬时弹性成像技术和声辐射力脉冲成像技术的定量评价

李国焕¹(), 谢旭¹, 黄志霞², 张铭业³, 唐云云³

1.珠海市中西医结合医院感染性疾病科, 广东珠海 519020
2.广东省中医院珠海医院肾病血透室, 广东珠海 519015
3.珠海高新技术产业开发区人民医院内一科, 广东珠海 519085

收稿日期:2021-06-02 出版日期:2021-06-20 发布日期:2021-07-13
通讯作者: 李国焕 E-mail:13825636139@163.com
基金资助:
广东省中医药局科研项目——不同程度非酒精性脂肪肝中医证型与肝脏剪切波速的相关研究(20192091)

Quantitative evaluation of transient elastography and acoustic radiation force pulse imaging for non-alcoholic fatty liver disease

Li Guohuan¹(), Xie Xu¹, Huang Zhixia², Zhang Mingye³, Tang Yunyun³

1. Department of Infectious Diseases, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine Hospital, Zhuhai 519020, China
2. Renal Disease Hemodialysis Room, Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 519015, China
3. First Department of Internal Medicine, Zhuhai High-tech Zone People's Hospital, Zhuhai 519085, China

Received:2021-06-02 Online:2021-06-20 Published:2021-07-13
Contact: Li Guohuan E-mail:13825636139@163.com

摘要/Abstract

摘要：

目的探讨非酒精性脂肪性肝病(NAFLD)的瞬时弹性成像技术(Fibro Scan)和声辐射力脉冲成像技术(ARFI)的定量评价价值。方法回顾性分析2019年1月~2021年1月间医院收治的90例NAFLD患者的临床资料,根据肝组织病理穿刺活检分为单纯脂肪肝组(38例)、非酒精性脂肪性肝炎(NASH)组(33例)、肝硬化组(19例),另取10例体检健康者为对照组。采用Fibro Scan、ARFI分别检测四组受检者的脂肪衰减参数(FAI值)、肝脏硬度值(LSM值)、声触诊组织量化测值(VTQ值)。比较NAFLD患者与对照组受检者及不同病情程度NAFLD患者的FAI值、LSM值、VTQ值差异,采用Spearman相关分析NAFLD患者病情程度与FAI值、LSM值、VTQ值间的关系,采用受试者工作特征曲线(ROC)分析FAI值、LSM值、VTQ值对NAFLD的诊断价值。结果 NAFLD患者的体质量指数(BMI)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均高于对照组受检者,而高密度脂蛋白胆固醇(HDL-C)低于对照组受检者,差异具有统计学意义(P<0.05),两组受检者的性别、年龄比较,差异无统计学意义(P>0.05)。NAFLD组患者的FAI值、LSM值、VTQ值均明显高于对照组受检者,不同病情程度NAFLD患者的FAI值、LSM值、VTQ值比较,差异具有统计学意义(P<0.05)。Spearman相关分析显示,LSM值、VTQ值均与NAFLD患者病情程度呈显著正相关(r=0.377、0.536,P<0.01),而FAI值与NAFLD患者病情程度呈显著负相关(r=-0.462,P<0.01)。ROC曲线显示,FAI值、LSM值、VTQ值对NAFLD具有一定的诊断价值(AUC=0.876、0.824、0.847,P<0.01)。结论瞬时弹性成像技术和声辐射力脉冲成像技术定量评价可用于NAFLD的病情分度,且在NAFLD临床诊断中具有良好发展前景。

关键词: 非酒精性脂肪性肝病, 瞬时弹性成像技术, 声辐射力脉冲成像技术, 定量评价

Abstract:

Objective To explore the quantitative evaluation value of transient elastography (Fibro Scan) and acoustic radiation force pulse imaging(ARFI) for non-alcoholic fatty liver disease(NAFLD). Methods The clinical data of 90 NAFLD patients admitted to the hospital from January 2019 to January 2021 were retrospectively analyzed and divided into the simple fatty liver (SFL) group (38 cases), nonalcoholic steatohepatitis(NASH) group (33 cases) and liver cirrhosis(LC) group (19 cases) according to liver tissue pathological biopsy, another 10 healthy people who had physical examination were selected as the control group. Fibro Scan and ARFI were used to detect the fat attenuation parameters (FAI value), liver stiffness measure value (LSM value), and virtual touch tissue quantification value (VTQ value) in the four groups. Differences in FAI, LSM, and VTQ between patients with and without NAFLD were compared; Spearman correlation was used to analyze the relationship between disease severity of NAFLD patients and FAI value, LSM value, VTQ value; receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of FAI, LSM, VTQ for NAFLD. Results Body mass index(BMI), alanine aminotransferase(ALT), aspartate aminotransferase(AST), total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL) of NAFLD patients were all higher than those of patients in the control group, while high-density lipoprotein cholesterol(HDL) was lower than that in the control group, difference was statistically significant (P<0.05). There was no statistically significant difference in gender and age (P>0.05). FAI value, LSM value, and VTQ value of NAFLD patients were significantly higher than those of patients in the control group. FAI value, LSM value and VTQ value of NAFLD patients with different disease severity were compared with statistical significance (P<0.05). Spearman correlation analysis showed that LSM value and VTQ value were significantly positively correlated with disease severity of NAFLD patients (r=0.377, 0.536, P<0.01), while FAI value was significantly negatively correlated with disease severity of NAFLD patients (r=-0.462, P<0.01). ROC curve showed that FAI, LSM, and VTQ had certain diagnostic value for NAFLD (AUC=0.876, 0.824, 0.847, P<0.01). Conclusion Transient elastography technology and ARFI technology can be used for the disease grading of NAFLD, and have good prospects for clinical diagnosis of NAFLD.

Key words: non-alcoholic fatty liver disease, transient elastography technology, acoustic radiation force pulse imaging technology, quantitative evaluation

中图分类号:

R575.5

李国焕, 谢旭, 黄志霞, 张铭业, 唐云云. 非酒精性脂肪性肝病的瞬时弹性成像技术和声辐射力脉冲成像技术的定量评价[J]. 临床荟萃, 2021, 36(6): 535-539.

Li Guohuan, Xie Xu, Huang Zhixia, Zhang Mingye, Tang Yunyun. Quantitative evaluation of transient elastography and acoustic radiation force pulse imaging for non-alcoholic fatty liver disease[J]. Clinical Focus, 2021, 36(6): 535-539.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.06.011

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I6/535

图/表 6

参考文献 16

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组别	例数	性别(例)		年龄 (岁)	BMI (kg/m²)	ALT (U/L)	AST (U/L)	TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)	LDL-C (mmol/L)
组别	例数	男	女	年龄 (岁)	BMI (kg/m²)	ALT (U/L)	AST (U/L)	TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)	LDL-C (mmol/L)
NAFLD组	90	48	42	42.60±10.66	26.30±3.90	38.37±5.41	32.61±9.65	5.94±1.30	2.12±0.58	1.10±0.21	3.23±0.65
对照组	10	6	4	42.71±10.75	23.71±2.47	20.45±3.95	24.87±6.23	4.74±1.06	1.41±0.41	1.34±0.19	2.67±0.79
χ²/t值		0.161		0.031	2.049	10.157	2.473	2.813	3.76	3.457	2.53
P值		0.688		0.975	0.043	<0.01	0.015	0.006	<0.01	0.001	0.013

组别	例数	性别(例)		年龄 (岁)	BMI (kg/m²)	ALT (U/L)	AST (U/L)	TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)	LDL-C (mmol/L)
组别	例数	男	女	年龄 (岁)	BMI (kg/m²)	ALT (U/L)	AST (U/L)	TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)	LDL-C (mmol/L)
NAFLD组	90	48	42	42.60±10.66	26.30±3.90	38.37±5.41	32.61±9.65	5.94±1.30	2.12±0.58	1.10±0.21	3.23±0.65
对照组	10	6	4	42.71±10.75	23.71±2.47	20.45±3.95	24.87±6.23	4.74±1.06	1.41±0.41	1.34±0.19	2.67±0.79
χ²/t值		0.161		0.031	2.049	10.157	2.473	2.813	3.76	3.457	2.53
P值		0.688		0.975	0.043	<0.01	0.015	0.006	<0.01	0.001	0.013

组别	例数	FAI值 (dB/m)	LSM值 (kPa)	VTQ值 (m/s)
对照组	10	208.45±21.92	3.59±1.02	1.14±0.18
NAFLD组	90	249.21±33.04	5.51±1.43	1.75±0.57
t值		5.279	4.122	7.517
P值		<0.01	<0.01	<0.01

组别	例数	FAI值 (dB/m)	LSM值 (kPa)	VTQ值 (m/s)
对照组	10	208.45±21.92	3.59±1.02	1.14±0.18
NAFLD组	90	249.21±33.04	5.51±1.43	1.75±0.57
t值		5.279	4.122	7.517
P值		<0.01	<0.01	<0.01

组别	例数	FAI值 (dB/m)	LSM值 (kPa)	VTQ值 (m/s)
单纯脂肪肝组	38	260.58±13.69	5.80±1.06	1.50±0.39
NASH组	33	296.63±19.41^*	6.76±1.38^**	1.91±0.48^**
肝硬化组	19	226.00±10.82^*#	8.36±1.90^*#	2.45±0.58^*#
F值		128.771	21.621	26.512
P值		<0.01	<0.01	<0.01

非酒精性脂肪性肝病的瞬时弹性成像技术和声辐射力脉冲成像技术的定量评价

Quantitative evaluation of transient elastography and acoustic radiation force pulse imaging for non-alcoholic fatty liver disease

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参考文献 16

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观察指标	病情程度
观察指标	r值	P值
FAI值	-0.462	<0.01
LSM值	0.377	<0.01
VTQ值	0.536	<0.01

检验项目	AUC	标准误	P值	95%CI		最佳临界值	敏感度	特异度	约登指数
检验项目	AUC	标准误	P值	下限	上限	最佳临界值	敏感度	特异度	约登指数
FAI值	0.876	0.048	<0.01	0.782	0.969	219.915	0.867	0.900	0.767
LSM值	0.824	0.067	0.001	0.694	0.954	4.975	0.522	1.000	0.522
VTQ值	0.847	0.062	<0.01	0.725	0.969	1.145	0.911	0.700	0.611

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