FibroScan技术联合血清骨钙素在绝经后女性非酒精性脂肪性肝病患者中的应用

Application of FibroScan technique combined with serum osteocalcin in postmenopausal women with nonalcoholic fatty liver disease

目的应用FibroScan测量肝脏脂肪衰减值、血清骨钙素(OC)评价绝经后女性非酒精性脂肪性肝病(NAFLD)患者肝脂肪变性程度。方法 2016年1月—2020年3月收治绝经后女性NAFLD患者126例,年龄(45.0±8.2)岁;NAFLD参照《非酒精性脂肪性肝病诊疗指南(2010年修订版)》标准。Spearman相关系数评价相关性;绘制ROC曲线评价诊断效能,以约登指数最大时确定诊断截断点。结果 126例绝经后女性NAFLD患者中,肝脂肪变性分期中S0期27例、S1期46例、S2期35例、S3期18例,各期FibroScan检测CAP值分别为(208.4±32.6)dB/m、(221.5±40.4)dB/m、(265.4±37.1)dB/m、(311.5±50.4)dB/m,具有显著差异(P<0.05);各期血清OC值分别为(23.1±2.4)ng/mL、(21.8±2.9)ng/mL、(20.4±1.8)ng/mL、(18.2±2.0)ng/mL,具有显著差异(P<0.05)。相关性分析提示绝经后女性NAFLD患者肝脂肪变性分期与CAP值呈显著性正相关(r=0.38,P<0.05),而与血清OC值呈显著性负相关(r=-0.27,P<0.05)。血清OC诊断绝经后女性NAFLD患者肝脂肪变性AUROC、截断点、敏感性、特异性分别为0.84、20.9 ng/mL、84.8%、83.6%;FibroScan检测CAP值诊断AUROC、截断点、敏感性、特异性分别为0.85、255.8 dB/m、76.0%、90.4%。联合诊断后AUROC、敏感性、特异性分别为0.90、88.2%、92.6%。结论血清OC、FibroScan测量CAP值对绝经后女性NAFLD患者肝脂肪变性具有较高的诊断价值,两者联合诊断后诊断效能进一步提升。

Objective The purpose of this study was to evaluate the degree of hepatic steatosis in postmenopausal women with nonalcoholic fatty liver disease(NAFLD)by measuring hepatic fat decay by FibroScan and serum osteocalcin(OC).Methods From Jan.2016 to Mar.20,2016 postmenopausal women with NAFLD were admitted and their age was(45.0±8.2)years old.NAFLD was based on the guidelines for diagnosis and treatment of non-alcoholic Fatty liver Disease(revised in 2010).The Spearman correlation coefficient is used to evaluate the correlation,the ROC curve is drawn to evaluate the diagnostic efficiency,and the diagnostic cutoff point is determined when the Jordan index reaches its maximum.Results Among the postmenopausal women with NAFLD,there were 27 cases of stage S0,46 cases of stage S1,35 cases of stage S2 and 18 cases of stage S3.The CAP values of FibroScan in each stage were(208.4±32.6)dB/m,(221.5±40.4)dB/m,(265.4±37.1)dB/m,(311.5±50.4)dB/m,respectively,and the serum OC values in each stage were(23.1±2.4)ng/ml,(21.8±2.9)ng/ml,(20.4±1.8)ng/ml,(18.2±2.0)ng/ml,respectively.Correlation analysis showed that the stage of hepatic steatosis in postmenopausal women with NAFLD was positively correlated with CAP(r=0.38,P<0.05),but negatively correlated with serum OC(r=0.27,P<0.05).The AUROC,cut-off point,sensitivity and specificity of serum OC in the diagnosis of hepatic steatosis in postmenopausal women with NAFLD were 0.84,20.9 ng/mL,84.8%and 83.6%,respectively.AUROC,cut-off point,sensitivity and specificity were 0.85,255.8 dB/m,76.0%and 90.4%,respectively.After combined diagnosis,the AUROC,sensitivity and specificity were 0.90,88.2%and92.6%,respectively.Conclusion The measurement of serum OC and FibroScan is of high value in the diagnosis of hepatic steatosis in postmenopausal women with NAFLD,and the diagnostic efficiency is further improved after the combined diagnosis of CAP and CAP.