多声学技术参数联合血清学指标对非酒精性脂肪性肝病肝脂肪变性阶段的诊断价值

Value of multiple acoustic technical parameters combined with serological indicators in diagnosis of hepatic steatosis

目的探讨多声学技术参数对非酒精性脂肪性肝病(NAFLD)脂肪变性阶段的诊断效能,并进一步探讨声学技术参数联合血清学参数是否能提高其诊断效能。方法从2020年6月至2021年12月前瞻性连续入组在浙江大学医学院附属第二医院就诊的临床可疑NAFLD并行肝穿刺活检的病例。所有病例穿刺前均经过衰减成像(ATI)、归一化局部方差(NLV)、肝肾强度对比(Ratio)值等肝多声学技术参数检查,同时收集患者临床背景数据和血清学数据。以病理结果为金标准,采用Spearman秩相关分析评估多声学技术参数和临床参数与肝脂肪变性之间的相关性,绘制受试者操作特征曲线评价多声学技术参数对肝脂肪变性的诊断效能,并探索最佳声学技术参数与血清学参数联合是否能提高NAFLD肝脂肪变性的诊断效能。结果本研究共纳入病例75例,其中肝脂肪变性分级S0、S1、S2、S3级分别为15、41、13、6例。肝脂肪变性分级与声学技术参数衰减系数(AC)值、Ratio值呈显著正相关(相关系数r=0.519、0.285,P<0.001、=0.016),与声学技术参数NLV、NLV的标准差(NLV-SD)呈显著负相关(r=-0.391、-0.356,P=0.001、0.002)。当AC值<0.62 dB/(cm·MHz)或谷草转氨酶(AST)<18 IU/L时,ATI和AST并联诊断肝脂肪变性≥S1级的曲线下面积(AUC)为0.864(95%CI:0.765~0.933),其敏感度和特异度分别为91.5%、80.0%;当AC>0.75 dB/(cm·MHz)且AST>25 IU/L时,ATI和AST串联诊断肝脂肪变性≥S2级的AUC为0.761(95%CI:0.645~0.854),其敏感度和特异度分别为55.6%、92.5%。结论在NAFLD患者中,声学技术参数AC、NLV、NLV-SD、Ratio值均在诊断肝脂肪变性分级中具有一定的价值。将AC值和血清学指标AST并联诊断可以进一步提高肝脂肪变性≥S1级的诊断效能,而AC值和AST串联诊断可以进一步提高肝脂肪变性≥S2级的诊断效能。

Objective To investigate the diagnostic performance of multiple acoustic technical parameters for hepatic steatosis,an early stage of non-alcoholic fatty liver disease(NAFLD),and to further explore whether acoustic technical parameters combined with serological indicators can improve the diagnostic performance.Methods We prospectively enrolled 75 consecutive patients with suspected NAFLD who underwent percutaneous liver biopsy for evaluation of hepatic steatosis from June 2020 to December 2021.All cases underwent liver multiparametric ultrasound to obtain the acoustic technical parameters attenuation coefficient(AC),normalized local variance(NLV),and liver and kidney ratio(Ratio)before the liver biopsy procedure.The clinical data and serological data of the patients were collected at the same time.The correlation between the acoustic technical parameters and clinical indicators with hepatic steatosis was assessed by Spearman rank correlation,the diagnostic performance of the acoustic technical parameters for hepatic steatosis was assessed by receiver operating characteristic curve analysis,and the diagnostic performance of optimal acoustic technical parameters combined with serological indicators for hepatic steatosis was also analyzed.Results A total of 75 cases were included in this study.The distribution of hepatic steatosis grades on histopathology was 15/41/13/6 for none(<5%,S0)/mild(5%-33%,S1)/moderate(>33%-66%,S2)/severe steatosis(>66%,S3),respectively.The AC value(r=0.519,P<0.001)and Ratio value(r=0.285,P=0.016)showed a significant positive correlation with hepatic steatosis,while the NLV value(r=-0.391,P=0.001)and NLV-SD value(r=-0.356,P=0.002)showed a significant negative correlation with hepatic steatosis.When AC<0.62 dB/(cm·MHz)or aspartate aminotransferase(AST)<18 IU/L,the AUC of the parallel diagnosis of ATI and AST for the detection of hepatic steatosis≥S1 grade was 0.864(95%confidence interval[CI]:0.765-0.933),with a sensitivity of 91.5%and specificity of 80.0%.When AC>0.75dB/(cm·MHz)and AST>25 IU/L,the AUC of the tandem diagnosis of ATI and AST for the detection of hepatic steatosis≥S2 grade was 76.1%(95%CI:0.645-0.854),with a sensitivity of 5.6%and specificity of 92.5%.Conclusion The acoustic technical parameters AC,NLV,NLV-SD,and Ratio have appreciated diagnostic performance in detecting varying degrees of hepatic steatosis in NAFLD patients.The parallel diagnosis of AC and AST can improve the diagnostic performance for hepatic steatosis≥S1 grade,while the tandem diagnosis of AC and AST can improve the diagnostic performance for hepatic steatosis≥S2 grade.