评价声辐射力脉冲成像诊断非酒精性脂肪性肝病纤维化的效能

Comparison of acoustic radiation force impulse and transient electrography for the diagnosis of fibrosis in patients with non-alcoholic fatty liver disease

目的比较声辐射力脉冲成像(ARFI)和瞬时弹性成像(TE)诊断非酒精性脂肪性肝病(NAFLD)患者肝纤维化程度的效能。方法研究回顾性纳入2012年9月至2017年6月在首都医科大学附属北京友谊医院行肝穿刺病理明确诊断为NAFLD的患者,在肝活检1周内分别应用ARFI和TE检测肝脏硬度;以病理作为金标准,采用曲线下面积(AUROC)比较两种技术对NAFLD肝纤维化的诊断价值。采用单因素和多因素分析影响ARFI测定值的影响因素。结果共纳入61例NAFLD患者,中位年龄为49岁,平均BMI为25.2 kg/m^2。对肝纤维化分期F0、F1、F2、F3和F4的患者,ARFI所得肝脏硬度值的中位数分别为1.0 m/s、1.4 m/s、1.5 m/s、1.9 m/s、2.5 m/s;TE所得的肝硬度值中位数分别为5.0 k Pa、6.8 k Pa、9.8 k Pa、12.0 k Pa、23.1 k Pa。两种技术所得肝脏硬度值与肝穿刺病理纤维化均相关,相关系数分别为0.801和0.798(P<0.001)。ARFI诊断F≥1、F≥2、F≥3、F=4曲线下面积分别为0.940、0.880、0.885、0.925,诊断界值(cut-off)分别为1.16、1.50、1.86、1.92 m/s。TE诊断F≥1、F≥2、F≥3、F=4曲线下面积分别为0.889、0.912、0.909、0.918,cut-off值分别为5.2、7.3、11.9、16.5 k Pa。多因素分析显示,ARFI测得的肝脏硬度值与气球样变、甘油三酯、血小板有关。结论 ARFI和TE诊断NAFLD患者中肝纤维化的诊断准确性类似,可作为诊断NAFLD患者中肝纤维化程度的可靠手段。

Objective To compare acoustic radiation force impulse(ARFI) and transient electrography(TE) for diagnosing fibrosis in patients with biopsy-proven non-alcoholic fatty liver disease(NAFLD).Methods The patients with biopsy-proven NAFLD were consecutively enrolled in this retrospective study from September 2012 to June 2017 in Beijing Friendship Hospital,Capital Medical University.Liver stiffnesses were measured by ARFI and TE within 1 week prior or inferior to liver biopsy.Histological evaluation of fibrosis was regarded as the gold standard.The diagnostic performances of ARFI and TE for fibrosis were evaluated using area under the receiver operating characteristic curves(AUROCs).The influencing factors for liver stiffness of ARFI and TE were explored using multivariate analysis.Results A total of 61 patients with biopsy-proven NAFLD were enrolled.The mean age and body mass index were 49 years and 25.2 kg/m^2,respectively.The median liver stiffness measured by ARFI in patients with F0,F1,F2,F3,and F4 fibrosis stages were 1.0,1.4,1.5,1.9,2.5 m/s;Those measured by TE were 5.0,6.8,9.8,12.0,23.1 k Pa.Liver stiffnesses by ARFI and TE were significantly correlated with liver fibrosis,and the correlation coefficients were 0.801 and 0.798,respectively(P < 0.001).For diagnosing F≥1,F≥2,F≥3 and F = 4,the AUROC for ARFI were 0.940,0.880,0.885,0.925,and the cut-off values were 1.16,1.50,1.86,1.92 m/s;the AUROCs for TE were 0.889,0.912,0.909,0.918 and the cut-off values were 5.2,7.3,11.9,16.5 k Pa,respectively.However,no significant difference of AUROCs existed between ARFI and TE for diagnosing the same stage of fibrosis(P > 0.005).Multivariate analysis demonstrated that ballooning,triglyceride(TG),platelet(PLT)were associated with ARFI values.Conclusion ARFI has a similar accuracy with TE for diagnosing liver fibrosis in NAFLD patients,and ARFI is a potential and valuable non-invasive technique for liver fibrosis assessment.