非酒精性脂肪性肝炎病理改变对肝脏剪切波速度的影响

Impact of pathological changes in nonalcoholic steatohepatitis on shear wave velocity of liver

目的探讨影响非酒精性脂肪性肝炎(NASH)患者肝脏剪切波速度(SWV)的病理因素。方法选择上海中医药大学附属曙光医院肝病科经肝组织穿刺活检诊断的NASH患者43例,其中男性28例,女性15例;年龄38~64岁,平均年龄48.61岁;轻度脂肪肝14例(S1组),中度脂肪肝23例(S2组),重度脂肪肝6例(S3组)。所有患者超声引导下穿刺活检前,均进行肝脏常规超声检查及声触诊组织定量分析(VTQ)。根据病理结果回顾性分析纤维化、脂肪浸润程度及炎症对NASH患者肝脏SWV的影响。结果经肝组织穿刺活检诊断的NASH患者43例,其中早期NASH 26例,纤维化性NASH 13例,肝硬化4例,不同时期的NASH肝脏SWV差异有统计学意义[早期NASH组与纤维化NASH组(1.15±0.10)m/s vs(1.25±0.10)m/s。P<0.01。早期NASH组与NASH肝硬化组(1.15±0.10)m/s vs(1.44±0.21)m/s。P<0.01。纤维化性NASH组与NASH肝硬化组(1.25±0.10)m/s vs(1.44±0.21)m/s。P=0.00]。比较各组脂肪含量不同肝脏SWV,S3组与S1组、S2组SWV的差异有统计学意义[(1.34±0.06)m/s vs(1.13±0.08)m/s,(1.34±0.06)m/s vs(1.21±0.16)m/s。P均<0.05]。根据炎症程度分为小叶炎症16例(G1组)、小叶炎症合并门静脉炎症20例(G2组)和小叶炎症合并小叶间炎症(或桥接坏死)7例(G3组),不同炎症程度NASH肝脏SWV之间差异有统计学意义[G3 vs G1(1.43±0.12)m/s vs(1.15±0.09)m/s;G3 vs G2(1.43±0.12)m/s vs(1.17±0.09)m/s。P均<0.01]。结论肝脏纤维化是影响NASH患者肝脏SWV值的重要因素,其次是脂肪肝的程度,炎症对NASH患者肝脏SWV值的影响最小。以上结果可为今后临床无创性评估NASH程度提供客观依据。

Objective To investigate the pathological factors affecting liver shear wave velocity(SWV)in patients with nonalcoholic steatohepatitis(NASH).Methods A total of 43 patients with NASH diagnosed by liver biopsy were enrolled,which included 28 males and 15 females,aged 38-64 years old with mean age of 48.61 years old.There were 14 cases of mild fatty liver(S1 group),23 of moderate fatty liver(S2 group)and 6 of severe fatty liver(S3 group).All of them underwent routine liver ultrasonography and virtual touch tissue quantification(VTQ)before ultrasound-guided biopsy.According to pathological results,the effects of fibrosis,fat infiltration and inflammation on liver SWV in NASH patients were retrospectively analyzed.Results There were 43 patients with NASH diagnosed by liver biopsy,which included 26 cases of early NASH,13 of fibrosis NASH and 4 of cirrhosis,the difference of liver SWV in different stages of NASH was statistically significant[Early NASH group and fibrosis NASH group(1.15±0.10)m/s vs(1.25±0.10)m/s.P<0.01.Early NASH group and NASH cirrhosis group(1.15±0.10)m/s vs(1.44±0.21)m/s.P<0.01.Fibrotic NASH group and NASH cirrhosis group(1.25±0.10)m/s vs(1.44±0.21)m/s.P=0.00].The SWV of liver with different fat content in each group was compared,and the difference of SWV between S3group,S1 group and S2 group was statistically significant[(1.34±0.06)m/s vs(1.13±0.08)m/s,(1.34±0.06)m/s vs(1.21±0.16)m/s.P<0.05].According to inflammation degree,all of them were divided into lobular inflammation(G1 group,n=16),lobular inflammation combined with portal vein inflammation(G2 group,n=20)and lobular inflammation combined with interlobular inflammation(or bridging necrosis)(G3 group,n=7),the difference of liver SWV in NASH with different degrees of inflammation was statistically significant[G3 vs G1(1.43±0.12)m/s vs(1.15±0.09)m/s;G3 vs G2(1.43±0.12)m/s vs(1.17±0.09)m/s.P<0.01].Conclusion It is demonstrated that liver fibrosis is the most important factor that affecting liver SWV value of NASH patient,followed by the degree of fatty liver,and the inflammation shows the least effect on liver SWV value in NASH patient.Those results provide objective evidences for non-invasive evaluation of NASH degree in future clinical diagnosis.