SWE及UAP参数评估肥胖青少年非酒精性脂肪性肝病肝脂肪变的临床价值

摘要/Abstract

摘要： 目的探究剪切波弹性成像(SWE)及超声衰竭参数(UAP)对肥胖青少年非酒精性脂肪性肝病(NAFLD)肝脂肪变程度的评估价值。方法回顾性选取2020年5月—2022年9月于江油市第二人民医院经肝穿刺活检确诊存在肝脏脂肪变性的NAFLD患者146例,收集患者资料,对其行肝脏生物化学检测,包括血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)、甘油三酯(TG)、总胆红素(TBil)、总胆固醇(TC)、低密度脂蛋白(LDL),计算其肝脂肪变性指数(HSI)。根据肝穿刺活检结果对患者进行肝脏脂肪变性分级(S0~S4),采用剪切波弹性成像超声诊断仪测量其肝脏硬度(LS)和脾脏硬度(SS),采用肝脏瞬时弹性扫描仪对患者行UAP测量,分析以上指标对肝脂肪变性分级的评估价值。结果本研究NAFLD患者经肝组织活检进行分级,其中S0级患者5例,S1级26例,S2级58例,S3级57例。不同肝脂肪变分级患者性别、年龄、GGT、TG、TC、TBil、LDL之间差异无统计学意义(均P>0.05),患者分级越高,BMI、ALT、AST、HSI、SWE中LS、SS和UAP水平越高(F=10.1817~290.9213,均P<0.05)。Spearman相关性分析显示,LS、SS和UAP与BMI、ALT、AST、HSI水平呈正相关性(r=0.450~0.587,均P<0.05),与性别、年龄等无相关性(均P>0.05)。SWE参数和UAP参数联合诊断肝脂肪变分级的整体效能高于单纯SWE参数或UAP参数(S2: AUC=0.881, 95%CI=0.796~0.966, S3: AUC=0.887, 95%CI=0.788~0.985,均P<0.05),其诊断S2级肝脂肪变的灵敏度和特异度分别为87.9%、87.1%,诊断S3级肝脂肪变的灵敏度和特异度分别为94.7%、87.1%。结论肥胖青少年NAFLD患者的肝脂肪变分级越高,LS、SS和UAP越高,SWE和UAP对其分级有较高的评估价值,两者联合诊断能提高其诊断效能。

关键词: 剪切波弹性成像, 超声衰竭参数, 非酒精性脂肪性肝病, 肝脂肪变性指数, 脾脏硬度

Abstract: Objective To explore the value of shear wave elastography (SWE) and ultrasound attenuation parameters (UAP) in evaluating the degree of liver steatosis in obese adolescents with non-alcoholic fatty liver disease (NAFLD). Methods 146 patients with NAFLD confirmed by liver biopsy in Jiangyou Second People's Hospital from May 2020 to September 2022 were retrospectively selected. Data were collected and liver biochemical tests including serum alanine transaminase (ALT), aspartic acid transaminase (AST), γ-glutamyltransferase (GGT), triglycerides (TG), total bilirubin (TBil), total cholesterol (TC), and low density lipoprotein (LDL) were performed to calculatethe hepatic steatosis index (HSI) . Based on the results of liver biopsy, patients were graded for liver steatosis (S0-S4), and liver stiffness (LS) and spleen stiffness (SS) were measured using a shear wave elastic imaging ultrasound diagnostic instrument. UAP was measured using a liver instantaneous elastic scanner to analyze the evaluation value of the above indicators for liver steatosis grading. Results In this study, NAFLD patients were classified by liver tissue biopsy, including 5 patients with S0 grade, 26 patients with S1 grade, 58 patients with S2 grade, and 57 patients with S3 grade. There was no statistically significant difference in gender, age, GGT, TG, TC, TBil, and LDL among patients with different liver steatosis grades (all P>0.05). The higher the patient grade, the higher the levels of BMI, ALT, AST, HSI, SWE parameters LS, SS, and UAP (F=10.1817~290.9213, all P<0.05). Spearman correlation analysis showed that LS, SS, and UAP were positively correlated with BMI, ALT, AST, and HSI levels (r=0.450~0.587, all P<0.05), but not with gender, age, etc. (all P>0.05). The overall efficacy of combined SWE parameters and UAP parameters in the diagnosis of fatty liver grade was higher than that of single SWE parameters or UAP parameters(S2: AUC=0.881, 95%CI=0.796~0.966, S3: AUC=0.887, 95%CI=0.788~0.985, all P<0.05). The Sensitivity and specificity of the combined SWE parameters and UAP parameters in the diagnosis of S2 grade fatty liver grade were 87.9% and 87.1%, respectively, and the sensitivity and specificity of the combined SWE parameters and UAP parameters in the diagnosis of S3 grade fatty liver grade were 94.7% and 87.1%, respectively. Conclusion The higher the grading of liver steatosis in obese adolescents with NAFLD, the higher the LS, SS, and UAP. SWE and UAP have high evaluation value for their grading, and their combined diagnosis can improve their diagnostic efficacy.

Key words: Shear wave elastography, Ultrasound attenuation parameters, Non-alcoholic fatty liver disease, Hepatic steatosis index, Spleen stiffness

杨宪碧, 黄卫东, 黄英. SWE及UAP参数评估肥胖青少年非酒精性脂肪性肝病肝脂肪变的临床价值[J]. 肝脏, 2025, 30(4): 542-547.

YANG Xian-bi, HUANG Wei-dong, HUANG Ying. The clinical value of shear wave elastography (SWE) and ultrasonic attenuation parameter (UAP) in evaluating hepatic steatosis in obese adolescents with non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2025, 30(4): 542-547.

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