二维超声剪切波弹性成像技术肝脏硬度测量在非酒精性脂肪性肝病疾病严重程度预测中的应用价值

Application value of liver hardness measurement by two-dimensional ultrasonic shear wave elastography in nonalcoholic fatty liver disease

目的 研究二维超声剪切波弹性成像技术(2D-SWE)肝脏硬度测量在非酒精性脂肪性肝病(NAFLD)疾病严重程度预测中的应用价值。方法 研究方法为回顾性分析,观察对象为2019年9月至2023年10月皖南医学院附属宣城市医院(宣城市人民医院)收治入院的122例NAFLD患者,设为研究组,并选取同一时期入院的122例健康体检者,设为对照组。两组研究对象均接受2D-SWE检查,比较肝硬度值。同时,参考脂肪性病变程度将研究组122例患者分为轻度组(n=63)与中重度组(n=59)。比较两组患者体重指数、生化指标[总胆红素、空腹血糖、高密度脂蛋白(HDL)、糖化血红蛋白(HbA1c)、甘油三酯、总胆固醇、低密度脂蛋白(LDL)],分析研究组2D-SWE硬度值与体重指数、生化指标的相关性,并分析2D-SWE硬度值对NAFLD严重程度的预测价值。结果 研究组患者的肝硬度值为(12.08±3.04) kPa,高于对照组[(6.98±2.93) kPa],差异有统计学意义(P<0.05)。中重度组肝硬度值为(12.28±3.07) kPa,高于轻度组[(8.39±2.76) kPa],轻度组、中重度组肝硬度值均高于对照组[(6.98±2.93) kPa],差异均有统计学意义(P<0.05)。中重度组患者的体重指数、空腹血糖、HbA1c、甘油三酯、总胆固醇、LDL水平分别为(31.12±4.34) kg/m^(2)、(6.24±0.76)μmol/L、(6.18±0.53) mmol/L、(3.16±0.58) mmol/L、(0.79±0.14) mmol/L、(3.26±0.75) mmol/L,均高于轻度组[(27.48±2.19) kg/m^(2)、(5.36±0.58)μmol/L、(5.27±0.36) mmol/L、(2.08±0.47) mmol/L、(0.61±0.13)mmol/L、(2.77±0.89) mmol/L],差异均有统计学意义(P<0.05)。经Pearson分析,研究组患者肝硬度与体重指数、空腹血糖、HbA1c、甘油三酯、总胆固醇、LDL均呈正相关(r=0.270、0.219、0.215、0.234、0.233、0.264,均P<0.05)。NAFLD程度预测中肝硬度值的受试者工作特征(ROC)曲线下面积为0.908,标准差0.025,P<0.01,95%置信区间(CI)为0.857~0.959。结论 NAFLD检查中2D-SWE肝脏硬度测量效果显著,肝脏硬度值与NAFLD密切相关,且可辅助预测患者疾病严重程度。

Objective To investigate the application value of two-dimensional ultrasonic shear wave elastography(2D-SWE) in liver hardness measurement in non-alcoholic fatty liver disease(NAFLD).Methods The study method was retrospective analysis.The observation subjects were 122 patients with NAFLD admitted from Xuancheng City Hospital Affiliated to Wannan Medical College(Xuancheng City People's Hospital) September 2019 to October 2023,and they were set as the study group,and 122 healthy subjects admitted during the same period were selected as the control group.Both groups underwent 2D-SWE examination,and the liver hardness values of the two groups were compared.At the same time,according to the degree of steatosis,122 patients in the study group were divided into the mild group(n=63) and the moderate and severe group(n=59).The body mass index and biochemical indices[total bilirubin,fasting blood glucose,high density lipoprotein(HDL),glycated hemoglobin(HbA1c),triacylglycerol,total cholesterol,low density lipoprotein(LDL)] of the two groups were compared,and the correlation between liver hardness and body mass index and biochemical indices of the study group was analyzed.The value of liver hardness in the prediction of NAFLD degree was analyzed.Results The liver hardness of the study group was(12.08±3.04) kPa,which was higher than that of the control group [(6.98±2.93) kPa],and the difference was statistically significant(P<0.05).The liver hardness of the moderate and severe group was(12.28±3.07) kPa,which was higher than that of the mild group [(8.39±2.76) kPa],the liver hardness values of the mild group and the moderate and severe group were higher than that of the control group[(6.98±2.93) kPa],and the differences were statistically significant(P<0.05).The body mass index,fasting blood glucose,HbA1c,triglycerides,total cholesterol,and LDL levels of patients in the moderate and severe group were(31.12±4.34) kg/m^(2),(6.24±0.76) μmol/L,(6.18±0.53) mmol/L,(3.16±0.58) mmol/L,(0.79±0.14) mmol/L,and(3.26±0.75) mmol/L,respectively,which were higher than those in the mild group [(27.48±2.19) kg/m^(2),(5.36±0.58) μmol/L,(5.27±0.36) mmol/L,(2.08±0.47) mmol/L,(0.61±0.13) mmol/L,(2.77±0.89) mmol/L],the differences were statistically significant(P<0.05).According to Pearson's analysis,liver hardness in the study group was positively correlated with body mass index,fasting blood glucose,HbA1c,triacylglycerol,total cholesterol and LDL(r=0.270,0.219,0.215,0.234,0.233,0.264,P<0.05).The area under curve of the receiver operating characteristic(ROC) curve for liver hardness value in the prediction of NAFLD degree was 0.908,and the standard deviation was 0.025,P<0.01,95% confidence interval was 0.857-0.959.Conclusion 2D-SWE liver hardness measurement is effective in NAFLD examination,liver hardness value is closely related to NAFLD,and can help predict the disease severity of patients.