FibroScan®实施受控衰减参数检测肝脂肪变的影响因素及应用价值分析

摘要/Abstract

摘要： 目的探讨FibroScan^®实施受控衰减参数(controlled attenuation parameter,CAP)无创定量检测肝脂肪变的影响因素及应用价值。方法纳入非酒精性脂肪性肝病患者46例,慢性乙型肝炎并肝脂肪变患者31例。以肝活检为“金标准”评价肝脂肪含量,其中肝脂肪变分级S0:<5％;S1:5％~33％;S2:34％~66％;S3:>66％。使用FibroScan-502机型及M探头对所有研究对象进行CAP值测定。分析CAP值与肝脂肪含量、人体学指标及生化学指标的相关性。结果肝脂肪变处于S0、S1、S2、S3的患者分别有12例、29例、31例、5例。CAP值随着肝脂肪变分级增加而增大,各级肝脂肪变患者CAP值差异具有统计学意义(χ²=36.990,P=0.000),相邻两级间CAP值差异均具有统计学意义(均P＜0.05);Spearman相关分析表明,CAP值与体质指数(BMI)(r=0.368,P=0.001)、腰围(r=0.298,P=0.008)、肝脂肪变分级(r=0.696,P=0.000)呈正相关,与年龄(r=-0.335,P=0.003)呈负相关。当控制了肝脂肪变分级后,偏相关分析显示,CAP值仍与BMI(r=0.242,P=0.035)、腰围(r=0.243,P=0.034)呈正相关,与年龄(r=-0.142,P=0.222)的相关关系消失;多元逐步回归分析显示,仅肝脂肪变分级是肝脏CAP值的独立影响因素;受试者工作特征曲线分析发现,CAP诊断肝脂肪变程度≥5%、≥34%、≥67%的曲线下面积分别为0.891(P=0.000)、0.862(P=0.000)、0.889(P=0.004),最佳临界值分别为279、318、332 dB/m。结论 FibroScan^®实施CAP无创定量检测肝脂肪变具有较好的应用价值,肝脂肪变分级是肝脏CAP值的独立影响因素。

关键词: 瞬时弹性记录仪, 受控衰减参数, 肝脂肪变, 影响因素

Abstract: Objective To investigate influential factors and clinical value of controlled attenuation parameters (CAP) in the measurement of hepatic steatosis using FibroScan^®. Methods Forty six patients with non-alcoholic fatty liver disease and 31 chronic hepatitis B patients with hepatic steatosis were enrolled in the study. Hepatic steatosis was graded by the liver lipids content pathologically: S0＜5%, S1: 5%-33%, S2: 34%-66%, S3＞66%. Measurement of CAP in all those cases carried out by FibroScan-502 and M probe, and its correlations with other factors, including hepatic steatosis grade, anthropometric parameters and biochemistry index, were also analyzed. Results Patients with hepatic steatosis were 12, 29, 31 and 5 in grade S0, S1, S2 and S3, respectively. The CAP value was positively correlated with hepatic steatosis grade, which was statistically significant different in each grade(χ²=36.990, P=0.000), as well as every adjacent two grades (P＜0.05). Spearman correlation analysis showed that CAP value had a positive correlation with BMI(r=0.368, P=0.001), waist circumference (r=0.298, P=0.008) and hepatic steatosis grade (r=0.696, P=0.000), but a negative correlation with age (r=-0.335, P=0.003). Setting hepatic steatosis grades as control variables, partial correlation analysis revealed that CAP value was still positively correlated with BMI (r=0.242, P=0.035) and waist circumference (r=0.243, P=0.034), but showed no correlation with age (r=-0.142, P=0.222). Stepwise multiple regression analysis showed that hepatic steatosis grade was the only independent influential factor for CAP value.In addition, the areas under the receiver operating characteristic curve (ROC) overall were 0.891(P=0.000), 0.862(P=0.000), 0.889(P=0.004) for steatosis ≥ 5%, ≥ 34% and ≥ 67%, respectively, and the optimal cut-off values were 279, 318 and 332 dB/m, respectively. Conclusion CAP of FibroScan^® had a satisfactory clinical value in quantitative evaluation of hepatic steatosis. Additionally, hepatic steatosis grade was an independent influencing factor for CAP value.

Key words: FibroScan^®; Controlled attenuation parameters; Hepatic steatosis; Influential factors

陈建能, 陈爱萍, 潘勤, 郭其裕, 沈峰, 郑瑞丹, 范建高. FibroScan^®实施受控衰减参数检测肝脂肪变的影响因素及应用价值分析[J]. 肝脏, 2016, 21(10): 805-809.

CHEN Jian-neng, CHEN Ai-ping, PAN Qin, GUO Qi-yu, SHEN Feng, ZHENG Rui-dan, FAN Jian-gao. Influential factors and clinical value of controlled attenuation parameters in the evaluation of hepatic steatosis using FibroScan^®[J]. Chinese Hepatolgy, 2016, 21(10): 805-809.

参考文献

[1] Fan JG, Farrell GC. Epidemiology of non-alcoholic fatty liver disease in China. J Hepatol, 2009,50: 204-210.
[2] Fan JG, Chitturi S. Hepatitis B and fatty liver: causal or coincidental? J Gastroenterol Hepatol, 2008, 23: 779-782.
[3] Zheng RD, Xu CR, Jiang L, et al. Predictors of hepatic steatosis in HBeAg-negative chronic hepatitis B patients and their diagnostic values in hepatic fibrosis. Int J Med Sci, 2010, 7: 272-277.
[4] Degos F,Perez P,Roche B,et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis:a multicenter prospective study.J Hepatol,2010,53:1013-1021.
[5] Sasso M,Beaugrand M,de Ledinghen V,et al. Controlled attenuation parameter(CAP):a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosispreliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol,2010,36:1825-1835.
[6] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南(2010 年修订版). 中华肝脏病杂志,2010,18:163-166.
[7] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版).肝脏,2015,20:915-932.
[8] 中华人民共和国卫生部疾病控制司. 中国成人超重和肥胖症预防控制指南. 北京:人民卫生出版社,2006:1-4.
[9] Chon YE, Jung KS, Kim SU,et al.Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population. Liver Int, 2014,34:102-109.
[10] van Meer S,van Erpecum KJ,Sprengers D,et al.Hepatocellular carcinoma in noncirrhotic livers is associated with steatosis rather than steatohepatitis: potential implications for pathogenesis. Eur J Gastroenterol Hepatol,2016. [Epub ahead of print].
[11] Nalbantoglu IL,Brunt EM. Role of liver biopsy in nonalcoholic fatty liver disease.World J Gastroenterol,2014,20:9026-9037.
[12] Sumida Y, Nakajima A, Itoh Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholicfatty liverdisease/nonalcoholic steatohepatitis. World J Gastroenterol,2014,20:475-485.
[13] Kinner S,Reeder SB,Yokoo T. Quantitative Imaging Biomarkers of NAFLD. Dig Dis Sci, 2016,61:1337-1347.
[14] Huang X, Xu M, Chen Y, et al. Validation of the Fatty Liver Index for Nonalcoholic Fatty Liver Disease in Middle-Aged and Elderly Chinese. Medicine,2015,94:e1682.
[15] Koplay M, Sivri M, Erdogan H, et al.Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease. World J Hepatol,2015,7:769-776.
[16] Sasso M,Tengher-Barna I,Ziol M,et al. Novel controlled attenuation parameter for noninvasive assessment of steatosis using Fibroscan:validation in chronic hepatitis C. J Viral Hepat,2012,19:244-253.
[17] Kumar M, Rastogi A, Singh T,et al.Controlled attenuation parameter for non-invasive assessment of hepatic steatosis: does etiology affect performance? J Gastroenterol Hepatol, 2013,28:1194-1201.
[18] Masaki K, Takaki S, Hyogo H,et al.Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients withchronic liver diseases. Hepatol Res,2013,43:1182-1189.
[19] de Lédinghen V, Vergniol J, Foucher J,et al.Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography.Liver Int, 2012,32:911-918.
[20] Recio E, Cifuentes C, Macías J,et al. Interobserver concordance in controlled attenuation parameter measurement, a novel tool for the assessment ofhepatic steatosis on the basis of transient elastography.Eur J Gastroenterol Hepatol, 2013,25:905-911.