SWE在MAFLD早期肝纤维化及肾纤维化中的应用价值

The application value of SWE in early hepatic fibrosis and renal fibrosis in MAFLD

目的探讨剪切波弹性成像(shear wave elastography,SWE)在评估代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)患者早期肝纤维化及肾纤维化中的应用价值。方法选取2023年7月至2024年5月于温州医科大学附属第二医院住院治疗的MAFLD患者52例作为MAFLD组,同期接受治疗的非MAFLD患者40例作为对照组。收集患者的一般资料、实验室检查和超声资料,比较两组患者各项指标的差异性和相关性,评价SWE弹性值在MAFLD患者肝纤维化和肾纤维化中的应用价值。结果MAFLD组患者的肝功能指标、尿酸及天冬氨酸转氨酶与血小板比值指数(aspartate aminotransferase-to-platelet ratio index,APRI)高于对照组(P<0.01);两组患者的纤维化-4指数、肾小球滤过率估计值、血肌酐和尿素氮之间的差异无统计学意义(P>0.05);MAFLD组患者的肝脏亮度、肝肾比及肝脏弹性值高于对照组(P<0.05);两组患者的右肾皮质弹性值比较,差异无统计学意义(P>0.05)。肝脏弹性值与丙氨酸转氨酶(alanine aminotransferase,ALT)呈正相关;肝肾比与体质量指数(bodymassindex,BMI)、ALT、天冬氨酸转氨酶、碱性磷酸酶、γ-谷氨酰转移酶和APRI呈正相关,右肾皮质弹性值与BMI、肾小球滤过率估计值、血肌酐、血尿素氮和血尿酸之间均无显著相关性。结论SWE有助于早期识别MAFLD患者的肝脏硬度的变化;SWE在MAFLD患者早期肾纤维化中的应用价值有待进一步评估。

Objective To explore the value of shear wave elastography(SWE)in the early assessment of hepatic and renal fibrosis in patients with metabolic associated fatty liver disease(MAFLD).Methods A total of 52 MAFLD patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from July 2023 to May 2024 were selected as MAFLD group,and 40 non-MAFLD patients treated during the same period were served as control group.General information,laboratory data and ultrasound data were collected and compared between two groups.The differences as well as the correlation of the indicators between two groups were compared.The value of SWE in hepatic fibrosis and renal fibrosis in MAFLD patients was assessed.Results Liver function indicators,uric acid and aspartate aminotransferase-to-platelet ratio index(APRI)in MAFLD group were higher than those in control group(P<0.01);There were no statistically significant differences between two groups in fibrosis 4 index,estimated glomerular filtration rate,serum creatinine and blood urea nitrogen(P>0.05).The brightness of the liver,liver-kidney ratio,and liver elasticity value were higher in MAFLD group than those in control group(P<0.05);There was no significant difference in the elasticity value of the right renal cortex between two groups(P>0.05).Liver elasticity values was positively correlated with alanine aminotransferase(ALT);The liver-kidney ratio was positively correlated with body mass index(BMI),ALT,aspartate aminotransferase,alkaline phosphatase,γ-glutamyl transferase and APRI.No significant correlation was found between the right renal cortex elasticity and BMI,estimated glomerular filtration rate,serum creatinine,blood urea nitrogen,or serum uric acid.Conclusion SWE helps in early identification of liver hardness in the MAFLD patients.But the application of SWE in early renal fibrosis in the MAFLD patients needs further evaluation.