声衰减成像定量评估非酒精性脂肪性肝病严重程度的临床价值

Clinical value of acoustic attenuation imaging in the quantitative assessment of severity of non-alcoholic fatty liver disease

目的探讨声衰减成像(ATI)定量评估非酒精性脂肪性肝病(NAFLD)严重程度的临床应用价值。方法选取于我院住院和门诊就诊的NAFLD患者120例,均行腹部CT、ATI和实验室生化检查,根据CT测得的肝脏与脾脏比值(LSR)判断脂肪肝严重程度并进行分级,以此分为无脂肪肝组(N0级)、轻度脂肪肝组(N1级)、中度脂肪肝组(N2级)、重度脂肪肝组(N3级),每组30例。应用ATI测量衰减系数(AC),比较各组AC、LSR及临床资料的差异;绘制受试者工作特征(ROC)曲线分析AC诊断不同程度脂肪肝的效能;Spearman相关分析法分析AC与LSR及临床资料的相关性。结果各组AC、LSR、体质量指数(BMI)、甘油三酯(TG)比较差异均有统计学意义(均P<0.05);轻、中、重度脂肪肝组AC均大于无脂肪肝组,差异均有统计学意义(均P<0.001),轻、中、重度脂肪肝组AC两两比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,AC诊断≥N1、≥N2、≥N3级脂肪肝的曲线下面积分别为0.860、0.960、0.997,对应的截断值分别为0.73、0.80、0.88 dB·cm^(-1)·MHz^(-1),灵敏度分别为83.33%、90.00%、96.67%,特异度分别为80.00%、86.67%、96.67%。相关性分析显示,AC与LSR、BMI、TG均相关(r=-0.66、0.21、0.14,均P<0.001)。结论应用ATI可以无创评估NAFLD严重程度,对临床诊断及随访均有重要的指导意义。

Objective To explore the clinical application value of acoustic attenuation imaging(ATI)in the quantitative assessment of severity of non-alcoholic fatty liver disease(NAFLD).Methods A total of 120 patients from the inpatient and outpatient departments of our hospital were selected.All of them underwent abdominal CT,ATI and laboratory biochemical examinations.The severity of fatty liver was determined and classified according to the ratio of liver to spleen measured by CT(LSR).They were divided into the non-fatty liver group(grade N0),the mild fatty liver group(grade N1),the moderate fatty liver group(grade N2),and the severe fatty liver group(grade N3),with 30 cases in each group.Attenuation coefficient(AC)was measured by ATI,and the differences in AC and laboratory parameters among the groups were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of AC in diagnosing different degrees of fatty liver.The Spearman method was employed to analyze the correlation between AC and LSR,clinical data.Results There were statistically significant differences in AC,LSR,body mass index(BMI),and triglyceride(TG)among the groups(all P<0.05).The AC in the mild,moderate,and severe fatty liver groups was higher than that in the non-fatty liver group,and the differences were statistically significant(all P<0.001).There were statistically significant differences in AC between the mial,moderate and severe fatty liver groups(all P<0.05).The ROC curve analysis showed that the area under the curve of AC for diagnosing grade≥N1,≥N2 and≥N3 fatty liver were 0.860,0.960 and 0.997,respectively,and the corresponding cutoff values were 0.73,0.80 and 0.88 dB·cm-1·MHz-1,respectively.The corresponding sensitivities were 83.33%,90.00%,96.67%,and specificities were 80.00%,86.67%,96.67%,respectively.Correlation analysis showed that AC was correlated with LSR,BMI and TG(all P<0.001).Conclusion ATI enables non-invasive assessment of severity of NAFLD and holds significant guiding significance for both clinical diagnosis and subsequent follow-up.