应用声辐射力脉冲成像无创定量评估儿童非酒精性脂肪性肝病及其严重程度

摘要/Abstract

摘要： 目的探讨声辐射力脉冲成像(ARFI)在儿童非酒精性脂肪性肝病(NAFLD)中的应用价值,评估其对疾病严重程度,尤其是显著纤维化的无创定量评估能力。方法分析苏州大学附属儿童医院接受ARFI检查的儿童84例,包括正常对照组(n=12)、单纯脂肪变组(n=33)、单纯非酒精性脂肪性肝炎(NASH)组(n=25)及NASH伴显著纤维化组(n=14)。比较各组 ARFI 剪切波速度差异,采用多因素logistic回归分析评估显著纤维化的影响因素,并通过ROC曲线评估ARFI对不同疾病阶段的诊断效能。结果正常对照组ARFI值(1.08±0.12)m/s,单纯脂肪变组(1.24±0.15)m/s,单纯NASH组(1.48±0.18)m/s,NASH伴显著纤维化组(1.86±0.22)m/s,ARFI值随NAFLD严重程度呈阶梯式升高,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,ARFI为显著纤维化(F≥2)的独立预测因素(OR=1.42,95% CI:1.18～1.71,P<0.001),而年龄、体质指数及ALT未显示独立相关性(P均>0.05)。ROC曲线分析显示,当ARFI截断值为1.62 m/s时,对显著纤维化的诊断效能最高,AUC为0.91,灵敏度85.7%,特异度88.4%。结论 ARFI能够无创、定量地反映儿童NAFLD不同疾病阶段肝脏硬度的变化,并可作为显著纤维化的独立预测指标。

关键词: 声辐射力脉冲成像, 非酒精性脂肪性肝病, 儿童, 肝纤维化

Abstract: Objective To investigate the clinical value of acoustic radiation force impulse (ARFI) imaging in pediatric nonalcoholic fatty liver disease (NAFLD) and to evaluate its ability to noninvasively and quantitatively assess disease severity, particularly significant fibrosis. Methods A total of 84 pediatric subjects who underwent ARFI examination were analyzed in the Children′s Hospital of Soochow University, including a normal control group (n=12), a simple steatosis (NAFL) group (n=33), a nonalcoholic steatohepatitis (NASH) group without significant fibrosis (n=25), and a NASH group with significant fibrosis (n=14). Differences in ARFI-derived shear wave velocity (SWV) among groups were compared. Multivariate logistic regression analysis was performed to identify factors associated with significant fibrosis, and receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of ARFI across different disease stages. Results Significant differences in ARFI-derived shear wave velocity (SWV) were observed among different disease stages (P<0.05). The mean ARFI values were (1.08±0.12) m/s in the control group, (1.24±0.15) m/s in the NAFL group, (1.48±0.18) m/s in the NASH group without significant fibrosis, and (1.86±0.22) m/s in the NASH group with significant fibrosis, showing a stepwise increase with disease severity. Multivariate logistic regression analysis demonstrated that ARFI was an independent predictor of significant fibrosis (F≥2) (OR=1.42 , 95% CI: 1.18~1.71, P<0.001), whereas age, BMI, and ALT were not independently associated (all P>0.05). ROC analysis indicated that an ARFI cutoff value of 1.62 m/s yielded the best diagnostic performance for significant fibrosis, with an AUC of 0.91, sensitivity of 85.7%, and specificity of 88.4%. Conclusion ARFI enables noninvasive and quantitative assessment of liver stiffness changes across different stages of pediatric NAFLD and serves as an independent predictor of significant fibrosis, demonstrating high clinical value for disease severity assessment and risk stratification in pediatric NAFLD.

Key words: Acoustic radiation force impulse imaging, Nonalcoholic fatty liver disease, Children, Liver fibrosis

陈小月, 孙鑫, 刘宇芳. 应用声辐射力脉冲成像无创定量评估儿童非酒精性脂肪性肝病及其严重程度[J]. 肝脏, 2026, 31(7): 1024-1027.

Chen Xiaoyue, Sun Xin, Liu Yufang. Noninvasive quantitative assessment of pediatric nonalcoholic fatty liver disease and its severity using acoustic radiation force impulse imaging[J]. Chinese Hepatolgy, 2026, 31(7): 1024-1027.

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