FibroScan受控衰减参数对非酒精性脂肪性肝病的诊断效能及与中医证型的相关性分析

Performance of controlled attenuation parameter measured by FibroScan in the diagnosis of nonalcoholic fatty liver disease and its association with traditional Chinese medicine syndrome types

目的探讨FibroScan检测肝脂肪变受控衰减参数(CAP)在非酒精性脂肪性肝病(NAFLD)的诊断及在中医辨证分型中的应用价值。方法回顾性收集2017年1月—2019年12月于河南中医药大学第一附属医院就诊的364例NAFLD患者的基本信息(年龄、性别、BMI)、FibroScan CAP值、肝胆脾胰超声检查结果以及肝功能、血脂指标,根据中医辨证分型分为肝郁脾虚证组、湿浊内停证组、湿热蕴结证组、痰瘀互结证组和脾肾两虚证组,分析CAP值、彩超、肝功能指标、血脂指标、BMI与中医证型之间的关系。符合正态分布的计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;不符合正态分布的计量资料多组间及进一步两组间比较采用多个独立样本Kruskal-Wallis H秩和检验。计数资料多组间及进一步两组间比较采用χ^(2)检验或Kruskal-Wallis H检验。采用Spearman秩相关分析CAP值与超声分级的相关性。结果364例NAFLD患者中,肝郁脾虚证169例,湿浊内停证71例,湿热蕴结证60例,痰瘀互结证41例,脾肾两虚证23例。不同证型之间CAP值差异有统计学意义(F=14.839,P<0.001),脾肾两虚证、痰瘀互结证与肝郁脾虚证、湿浊内停证、湿热蕴结证相比CAP值升高更明显(P值均<0.05);不同证型超声分级差异有统计学意义(χ^(2)=22.947,P<0.001),其中肝郁脾虚证以轻度为主(40.2%),湿浊内停证和湿热蕴结证以中度为主(53.5%、53.3%),痰瘀互结证、脾肾两虚证以重度为主(68.3%、43.5%);CAP值与脂肪肝严重程度呈正相关(r=0.431,P<0.001);脾肾两虚证和痰瘀互结证患者ALT、AST、GGT和BMI水平与其他3个证型患者相比升高更明显(P值均<0.001)。结论CAP与NAFLD中医证型之间存在关联性,痰瘀互结证与脾肾两虚证NAFLD患者CAP值相较于其他证型更高。CAP与彩超相比诊断NAFLD的效能相似。

Objective To investigate the application value of controlled attenuation parameter(CAP)of hepatocyte steatosis measured by FibroScan in the diagnosis and traditional Chinese medicine(TCM)syndrome differentiation of nonalcoholic fatty liver disease(NAFLD).Methods A retrospective analysis was performed for related data of 364 patients with NAFLD who attended The First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2017 to December 2019,including basic information(age,sex,and body mass index[BMI]),CAP measured by FibroScan,ultrasound findings of the liver,gallbladder,spleen,and pancreas,liver function parameters,and blood lipid parameters.TCM syndrome differentiation was performed based on the information obtained by four diagnostic methods,and then the patients were divided into liver depression and spleen deficiency group,damp turbidity and stagnation group,damp-heat accumulation group,intermingled phlegm and blood stasis group,and spleen-kidney deficiency group.The association of CAP,color Doppler ultrasound findings,liver function parameters,blood lipid parameters,and BMI with TCM syndrome was analyzed.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups;the Kruskal-Wallis H rank sum test with multiple sets of independent samples was used for comparison of non-normally distributed continuous data between multiple groups and further comparison between two groups.The chi-square test or Kruskal-Wallis H rank sum test was used for comparison of categorical data between multiple groups and further comparison between two groups.A Spearman’s rank correlation analysis was used to investigate the correlation between CAP and ultrasound grading.Results Among the 364 patients with NAFLD,169 had the syndrome of liver depression and spleen deficiency,71 had the syndrome of damp turbidity and stagnation,60 had the syndrome of damp-heat accumulation,41 had the syndrome of intermingled phlegm and blood stasis,and 23 had the syndrome of spleen-kidney deficiency.There was a significant difference in CAP value between the different syndrome types(F=14.839,P<0.001),and further comparison between two groups showed that the spleen-kidney deficiency group and the intermingled phlegm and blood stasis group had a significantly higher CAP value than the liver depression and spleen deficiency group,the damp turbidity and stagnation group,and the damp-heat accumulation group(all P<0.05).There was a significant difference in ultrasound grading between the different syndrome types(χ^(2)=22.947,P<0.001);the liver depression and spleen deficiency group mainly had a mild grade(40.2%),the damp turbidity and stagnation group and the damp-heat accumulation group mainly had a moderate grade(53.5%and 53.3%,respectively),and the intermingled phlegm and blood stasis group and the spleen-kidney deficiency group mainly had a severe grade(68.3%and 43.5%,respectively).CAP was positively correlated with the severity of fatty liver(r=0.431,P<0.001).The spleen-kidney deficiency group and the intermingled phlegm and blood stasis group had significantly higher levels of alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transpeptidase,and BMI than the other three groups(all P<0.001).Conclusion Association is observed between CAP and the TCM syndrome types of NAFLD,and patients with the syndrome of spleen-kidney deficiency and the syndrome of intermingled phlegm and blood stasis have a higher CAP value than those with the other syndrome types.CAP has similar efficiency to color Doppler ultrasound in the diagnosis of NAFLD.