Fibrotouch受控衰减参数评价肝细胞脂肪变的相关影响因素

Factors affecting accuracy of controlled attenuation parameter by Fibrotouch in assessing hepatic steatosis

目的探索非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者肝脏的受控衰减参数(controlled attenuation parameters,CAP)的相关影响因素.方法收集2015-12/2016-12就诊于郑州大学第一附属医院经肝穿病理确诊的NAFLD的患者,肝穿前行Fibrotouch检测并记录受控衰减参数检测值,另收集临床资料[性别、年龄、体质量指数(body mass index,BMI)、谷丙转氨酶、甘油三酯(triglyceride,TG)、空腹胰岛素、脂肪变程度、小叶内炎症、气球样变、纤维化分期,通过多重线性回归分析CAP的影响因素.结果多重线性回归分析示CAP值与BMI、TG、脂肪变程度、气球样变呈正相关(F=18.202,P<0.001),标准回归系数分别为:BMI:β=0.216、P=0.024;TG:β=0.269、P=0.022;脂肪变程度:β=0.448、P=0.000;气球样变:β=0.200、P=0.039.模型为:CAP=183.574+1.866×BMI+4.527×TG+15.602×脂肪变程度+10.503×气球样变.此外,本文还对不同程度肝细胞脂肪变的胰岛素水平进行单因素方差分析:F=2.664,P>0.05,提示不同胰岛素的值对区分不同程度脂肪变无意义.结论 CAP的值受BMI、TG、脂肪变程度、气球样变的影响.

AIM To explore the factors influencing controlled attenuation parameter （CAP） obtained by Fibrotouch in patients with non-alcoholic fatty liver disease （NAFLD）. METHODS Patients with NAFLD diagnosed by liver biopsy in the First Affiliated Hospital of Zhengzhou University from December 2015 to December 2016 were collected. CAP was detected and recorded by Fibrotouch before liver biopsy. Clinical data were collected, including gender, age, body mass index （BMI）, alanine transaminase, triacylglycerol （TG）, fasting insulin, steatosis, lobular inflammation, ballooning, and fibrosis stage. Multiple linear regression analysis was used for identifying the factors influencing CAP. RESULTS Multiple linear regression analysis showed that CAP value was positively correlated with BMI （β = 0.216, P = 0.024）, TG （β = 0.269, P = 0.022）, steatosis （β = 0.448, P = 0.000）, and ballooning （β = 0.200, P = 0.039） （F = 18.202, P 〈 0.001）. The regression equation was CAP = 183.574 ＋ 1.866 x BMI ＋ 4.527 x TG ＋ 15.602 x steatosis ＋ 10.503 x ballooning. Single factor variance analysis of insulin level was performed in different degrees of hepatic steatosis, which suggested that insulin level had no significance to distinguish different degrees of steatosis （F = 2.664, P 〉 0.05）.CONCLUSION The value of CAP is affected by BMI, TG, steatosis, and ballooning.