剪切波组织定量技术对转氨酶异常的非酒精性脂肪肝弹性值检测价值的研究

The detection value of elastography point quantification on the elastic value of non-alcoholic fatty liver disease with abnormal transaminase

目的 分析剪切波组织定量技术(elastography point quantification,Elast PQ)对转氨酶异常的非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)弹性值的检测价值。方法 选取2017年1月至2018年1月广东省人民医院南海医院收治的160例NAFLD患者纳入研究组,依据转氨酶水平是否异常分为甲组(异常, n =80)与乙组(无异常, n =80),并选取同期40名健康志愿者作为对照组,比较3组腰臀比(WHR)、体质量指数(BMI)、Elast PQ值,比较研究组与对照组患者代谢指标、Elast PQ值;按照肝脏脂肪含量差异,将研究组分为轻度组、中度组与重度组,分析脂肪肝分度与Elast PQ值,Elast PQ值与代谢指标之间的相关性。结果 3组 WHR、BMI大小为:甲组>乙组>对照组,Elast PQ值大小为:对照组>乙组>甲组,差异有统计学意义(P<0.05);研究组TG、CHO、LDL-C水平明显高于对照组(P<0.05),且Elast PQ值明显低于对照组(P<0.05);脂肪肝分度与Elast PQ值呈负相关(P<0.05);Elast PQ值与AST/ALT呈正相关(P<0.05);ROC 曲线最大面积0.93±0.10,95% CI 为0.985~1.00,灵敏度 92.74%,特异度100%,Elast PQ 值= 4.23 kPa是最佳临界点。结论 Elast PQ联合相关指标检测可用于NAFLD定量评估,具有较高准确性,为患者临床诊治提供重要参考依据。

Objective To analyze the detection value of elastography point quantification(Elast PQ) on the elastic value of non-alcoholic fatty liver disease(NAFLD) with abnormal transaminase.Methods One hundred and sixty patients with NAFLD who were admitted to Nanhai Hospital, Guangdong People’s Hospital from Jan. 2017 to Jan. 2018 were included in study group and they were divided into group A(abnormality, n=80) and group B(no abnormality, n=80) according to whether the transaminase level was abnormal or not. Another 40 healthy volunteers in the same period were included in control group. The waist-to-hip ratio(WHR), body mass index(BMI) and Elast PQ value were compared among the 3 groups, and the metabolic indexes and Elast PQ were compared between study group and control group. According to the liver fat content, study group was divided into mild, moderate and severe groups. The correlations between fatty liver grading and Elast PQ value, between Elast PQ value and metabolic indexes were analyzed. Results The WHR and BMI among the 3 groups showed group A>group B>control group, and the Elast PQ value showed control group> group B>group A(P<0.05). The levels of TG, CHO and LDL-C in study group were significantly higher than those in control group(P<0.05), while the Elast PQ value was significantly lower than that in control group(P<0.05). The fatty liver grading was negatively correlated with the Elast PQ value(P<0.05). The Elast PQ value was positively correlated with the AST/ALT(P<0.05). The maximum area of ROC curve was 0.93±0.10, and the 95% CI was 0.985-1.00, and the sensitivity and specificity were 92.74% and 100%, and the best critical point was when Elast PQ value was 4.23 kPa.Conclusion Elast PQ combined with related indexes can be used for quantitative evaluation of NAFLD, and it has high accuracy and provides important reference for clinical diagnosis and treatment of patients.