瞬时弹性测定仪测定受控衰减参数在脂肪性肝病中的应用价值

Value of Fibro Scan in the Detection of Controlled Attenuation Parameters for Fatty Liver Disease

目的探讨瞬时弹性测定仪(Fibro Scan)测定受控衰减参数(CAP)在区分不同原因所致的脂肪性肝病(FLD)中的价值。方法选取2013年10月—2014年12月于首都医科大学附属北京世纪坛医院行超声检查测定肝脏硬度及脂肪变,并确诊为FLD的患者524例,根据病因将患者分为非酒精性脂肪性肝病(NAFLD)组406例,慢性乙型病毒性肝炎(CHB)合并NAFLD组69例,酒精性肝病(ALD)组49例。另选择门诊就诊查抗线粒体抗体M2(AMA-M2)阳性患者48例为AMA-M2组。患者均经腹部超声诊断为FLD。记录患者的一般资料,并检测肝功能、血脂等指标。由经过专门培训的医师测定CAP,取右腋前线和腋中线第7、8肋间捕获10次回波,取中位数(M)作为CAP。结果各组丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)水平比较,差异均无统计学意义(P>0.05)。各组性别、年龄、体质指数(BMI)、天冬氨酸氨基转移酶(AST)、γ-谷酰转肽酶(GGT)、总胆固醇(TC)水平比较,差异均有统计学意义(P<0.05)。各组CAP比较,差异有统计学意义(P<0.05);其中,CHB合并NAFLD组、ALD组、AMA-M2组CAP低于NAFLD组,CHB合并NAFLD组CAP低于ALD组,差异均有统计学意义(P<0.05)。结论应用Fibro Scan测定CAP有助于区分不同原因所致的FLD患者。

Objective To investigate the value of Fibro Scan in the detection of controlled attenuation parameters（ CAP） for distinguishing fatty liver disease（ FLD） patients with different etiological factors. Methods From October 2013 to December 2014,we enrolled 524 patients who received ultrasonic examination of liver stiffness and fatty change and were definitely diagnosed as FLD in Beijing Shijitan Hospital,Capital Medical University. According to etiological factors,the patients were divided into three groups： NAFLD group（ n = 406）,CHB ＋ NAFLD group（ n = 69） and ALD group（ n = 49）. We also enrolled 48 patients with AMA-M2 positive as AMA-M2 group. All the patients were diagnosed as FLD by abdominal ultrasound. The general data of the patients were recorded, and the detection of liver function and blood lipid were also conducted. Doctors who had received special training measured CAP value. They captured echos for 10 times between the 7th and 8th rib of the right axillary front and the right midaxillary line,and took the median as CAP. Results Different groups were not significantly different in the levels of ALT, ALP, TG, LDL-C and HDL-C（ P〉0. 05）. Different groups were significantly different in gender,age,BMI,AST,GGT and TC（ P〈 0. 05）. Different groups were significantly different in CAP（ P〈 0. 05）; CHB ＋ NAFLD group,ALD group and AMA-M2 group were lower than NAFLD group in CAP, and CHB ＋ NAFLD group was lower than ALD group in CAP（ P〈 0. 05）. Conclusion The application of Fibro Scan in the determination of CAP could help distinguish FLD patients with different etiological factors.