超声衰减参数评估慢性肝病患者肝脏脂肪变性程度的临床价值分析

Analysis of the clinical value of ultrasound attenuation parameters in evaluating liver steatosis degree in patients with chronic liver disease

目的评估超声衰减参数(UAP)诊断慢性肝病患者肝脏脂肪变性程度的临床价值,并探讨影响UAP检测值的相关因素。方法选择2014年1月至2019年5月就诊于河北医科大学第三医院中西医结合肝病科并经肝穿刺活组织检查诊断存在肝脏脂肪变性的慢性肝病患者130例,应用iLivTouch检测UAP以及肝脏硬度(LSM);计算患者体质量指数(BMI);同时测定患者血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转移酶(GGT)、总胆红素(TBil)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)水平和外周血小板(PLT)计数。以肝组织病理学结果为依据,分析UAP与肝脏脂肪变性程度的相关性。应用SPSS 21.0统计学软件进行统计学分析,采用受试者工作特征曲线(ROC)分析UAP诊断慢性肝病患者肝脏脂肪变性程度的准确性及特异性,Spearman秩相关分析研究影响UAP值的相关因素。结果经肝穿刺活组织学检查,诊断为肝脏脂肪变性程度F1级43例,F2级47例,F3级32例,F4级8例;UAP与BMI(r=0.363,P<0.001)、UAP与肝脏脂肪变性程度(r=0.380,P<0.001)呈正相关。BMI和肝脏脂肪变性程度为UAP值的独立预测因素;UAP诊断肝脏脂肪变性程度F≥2、F≥3和F=4的截断点分别为276 dB/m、288 dB/m、293 dB/m,其敏感度分别为0.379、0.500、0.750,特异度分别为0.930、0.922、0.836。结论超声衰减参数不仅可以明确慢性肝病患者是否存在肝脏脂肪变性,还可以较好地评估其肝脏脂肪变性程度。

Objective To evaluate the clinical value of ultrasound attenuation parameters(UAP)in diagnosing the liver steatosis degree in patients with chronic liver disease,and to explore the relevant factors that affect UAP detection values.Methods 130 cases with chronic liver disease diagnosed as liver steatosis by liver biopsy during January 2014 to May 2019 were selected from the Hepatology Department of Integrated Traditional Chinese and Western Medicine of the Third Hospital of Hebei Medical University.UAP and liver stiffness(LSM)were detected by iLivTouch,and the body mass index(BMI)was calculated.Simultaneously,serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyltransferase(GGT),total bilirubin(TBil),triglycerides(TG),total cholesterol(TC),low-density lipoprotein(LDL)levels and peripheral platelet(PLT)counts were measured.The correlation between UAP and liver steatosis was analyzed based on the liver histopathological results.SPSS 21.0 statistical software was used for statistical analysis.Receiver operating characteristic curve(ROC)was used to analyze the accuracy and specificity of UAP in the diagnosis of liver steatosis in patients with chronic liver disease.Spearman’s rank correlation analysis was used to study the relevant factors affecting UAP value.Results The histopathological changes of liver biopsy showed that there were 43 cases of grade F1,47 cases of F2,32 cases of F3 and 8 cases of F4.UAP and BMI(r=0.363,P<0.001),and UAP and liver steatosis degree(r=0.380,P<0.001)were positively correlated.BMI and the liver steatosis degree were independent predictors of UAP value.The cut-off points for UAP to diagnose liver steatosis degree were 276 dB/m for F≥2,288 dB/m for F≥2,293 dB/m for F≥3,and F=4,respectively.The sensitivity and specificity was 0.379,0.500,0.750,and 0.930,0.922,0.836,respectively.Conclusion Ultrasonic attenuation parameters cannot only determine the presence or absence of liver steatosis in patients with chronic liver disease,but also can better assess the liver steatosis degree.