FibroScan~实施受控衰减参数诊断脂肪肝的价值

被引：5

作者：

徐亮

李萍

陆伟

史琦玉

石瑞芳

张孝盈

刘勇钢

王秋静

范建高

宓余强

机构：

[1] 天津市第二人民医院天津市肝病医学研究所

[2] 天津医科大学

[3] 上海交通大学医学院附属新华医院消化科

来源：

中华肝脏病杂志 | 2016年 / 02期

关键词：

脂肪肝; 慢性; 肝病; 受控衰减参数; 无创诊断;

D O I：

暂无

中图分类号：

R575.5 [肝代谢障碍];

学科分类号：

1002 ; 100201 ;

摘要：

目的探讨FibroScan实施受控衰减参数(CAP)在慢性肝病(CLD)患者中诊断脂肪肝的价值。方法前瞻性研究2013年2月至2014年5月于天津市第二人民医院行肝组织病理检查并在1周内行CAP检测的慢性乙型肝炎(CHB)、慢性丙型肝炎(CHC)。非酒精性脂肪肝患者,依据指南将肝脂肪变分为S0<5%,S1:5%~33%,S2:34%~66/,S3:≥67%。以阳性为诊断标准绘制ROC曲线,Youden index最大时选取最佳cut-off值。采用一元线性相关回归与多元逐步回归分析CAP的影响因素。结果共纳入427例患者,NAFLD 19例(4.4%),CHB 383例(89.7%),CHC 25例(5.9%)。CAP诊断肝脂肪变≥5%,≥34%和≥67%的最佳cut-off值分别为230(dB/m),252(dB/m)及283(dB/m)(AUROC值分别为0.803,0.942,0.938,Z值分别为14.194,28.385,16.486,P值均<0.01)。CAP能区分S0与S1,S1与S2,S0与S2,S0与S3,S1与S3(Z值分别为10.109,10.224,47.81,29.917,10.999,P值均<0.01),但不能区分S2与S3(Z=0.656,P=0.5116)。一元线性相关回归分析及多元逐步回归分析提示仅人体质量指数(BMI)(B=4.001,P<0.01)及肝脂肪变性(B=33.015,P<0.01)与CAP有相关性。CAP与肝组织病理诊断的符合率:与S0为77.4%,与S3为81.0%,与≥S2为96.2%。结论 CAP对CLD患者脂肪肝的诊断具有很好的应用价值,能很好区分除S2与S3之外的任何脂肪肝分级;但受BMI影响,未发现与肝纤维化、炎症、肝脏硬度值(LSM)及病因等因素有关。

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