受控衰减参数对非酒精性脂肪肝病理学分度的诊断价值

Value of controlled attenuation parameter in diagnosing nonalcoholic fatty liver disease

目的:探讨受控衰减参数(controlled attenuation parameters,CAP)对非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)病理学分度的诊断价值.方法:选取2012-01/2015-03在广东省中医院肝病科行肝组织学检查诊断为NAFLD的146例患者为研究对象,使用Fibroscan对所有患者进行CAP值测定,分析CAP值与肝脂肪含量、体质量指数(body mass index,BMI)、生化学指标等的相关性.应用受试者工作(receiver operating curve,ROC)曲线分析判定CAP对NAFLD病理学分度的诊断价值.结果:共入组146例NAFLD患者,其中单纯N A F L D患者58例,N A F L D合并慢性乙型肝炎(chronic hepatitis B,CHB)患者88例.肝病理学分度为肝脂肪变及轻、中、重度脂肪肝的患者分别为49例、52例、25例、20例.C A P值随着脂肪肝病理学分度的加重而增大,组间两两比较存在显著性差异(均P<0.05).C A P值的相关性分析发现C A P值与BMI(r=0.54,P<0.05)、肝脂肪变程度(r=0.848,P<0.05)呈正相关,而与谷丙转氨酶(alanine transaminase,ALT)、谷草转氨酶(aspartate transaminase,AST)、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、肝脏炎症及纤维化程度等无明显相关.以CAP判断肝细胞脂变、轻、中、重度脂肪肝绘制ROC曲线,曲线下面积分别为0.818、0.917和0.789,最佳临界值分别为252.50、281.50、326.50 d B/m.结论:受控衰减参数对非酒精性脂肪肝病理学分度有较高的诊断价值.

AIM：To assess the value of controlled attenuation parameter（CAP） in diagnosing nonalcoholic fatty liver disease（NAFLD）.METHODS：From January 2012 to March 2015,146 NAFLD patients diagnosed by biopsy were enrolled in this study.CAP measurement was conducted by Fibroscan in all patients.The relationships between CAP and body mass index（BMI）,aspartate transaminase（ALT）,blood lipids and hepatic steatosis were analyzed,and the area under the receiver operating characteristic curve（AUC） was used to determine the diagnostic accuracy of CAP for NAFLD.RESULTS：A total of 146 patients were recruited,including 58 patients with NAFLD alone and 88 patients with NAFLD and chronic hepatitis B（CHB）.CAP was found to be positively correlated with BMI（r = 0.54,P〈0.05） and hepatic steatosis（r = 0.848,P〈0.05）,while there was no relationship between CAP and ALT,AST,blood lipid,liver inflammation grade or fibrosis stage.The cut-offs for the CAP values in patients with hepatic steatosis us mild steatosis,mild steatosis us moderate steatosis,moderate steatosis us severe steatosis were 252.50 dB/ m,281.50 dB/ m,and 326.50dB/ m,respectively,with AUROC of 0.818,0.917 and 0.789,respectively.CONCLUSION：Controlled attenuation parameter appears to be a promising tool for diagnosing NAFLD.