Hepburn Matthew J, Vos Jeffrey A, Fillman Eric P, Lawitz Eric J
Department of Medicine, Brooke Army Medical Center, Fort Sam, Houston, Texas, USA.
BMC Gastroenterol. 2005 Apr 13;5:14. doi: 10.1186/1471-230X-5-14.
Steatosis is occasionally reported during screening ultrasonography in patients with hepatitis C virus (HCV). We conducted a retrospective observational study to assess the factors associated with steatosis on ultrasonography and the relationship between steatosis on ultrasound versus biopsy in patients infected with HCV in a clinical setting. Our hypothesis was ultrasonography would perform poorly for the detection of steatosis outside of the context of a controlled study, primarily due to false-positive results caused by hepatic fibrosis and inflammation.
A retrospective review of ultrasound reports was conducted on patients infected with HCV in a tertiary care gastroenterology clinic. Reports were reviewed for the specific documentation of the presence of steatosis. Baseline clinical and histologic parameters were recorded, and compared for patients with vs. without steatosis. Multiple logistic regression analysis was performed on these baseline variables. Liver biopsies were reviewed by two pathologists, and graded for steatosis. Steatosis on biopsy was compared to steatosis on ultrasound report, and the performance characteristics of ultrasonography were calculated, using biopsy as the gold standard.
Ultrasound reports were available on 164 patients. Patients with steatosis on ultrasound had a higher incidence of the following parameters compared to patients without steatosis: diabetes (12/49 [24%] vs. 7/115 [6%], p < 0.001), fibrosis stage > 2 (15/48 [31%] vs. 16/110 [15%], p = 0.02), histologic grade > 2 (19/48 [40%] vs. 17/103 [17%], p = 0.002), and ALT (129.5 +/- 89.0 IU/L vs. 94.3 +/- 87.0 IU/L, p = 0.01). Histologic grade was the only factor independently associated with steatosis with multivariate analysis. When compared to the histologic diagnosis of steatosis (n = 122), ultrasonography had a substantial number of false-positive and false-negative results. In patients with a normal ultrasound, 8/82 (10%) had > 30% steatosis on biopsy. Among patients with steatosis reported on ultrasound, only 12/40 (30%) had > 30% steatosis on biopsy review.
Steatosis on ultrasound is associated with markers of inflammation and fibrosis in HCV-infected patients, but does not consistently correlate with steatosis on biopsy outside of the context of a controlled study. Clinicians should be skeptical of the definitive diagnosis of steatosis on hepatic ultrasonography.
在丙型肝炎病毒（HCV）患者的筛查超声检查中偶尔会报告肝脂肪变性。我们进行了一项回顾性观察研究，以评估超声检查中与肝脂肪变性相关的因素，以及在临床环境中感染HCV的患者中超声检查与活检之间肝脂肪变性的关系。我们的假设是，在对照研究之外，超声检查对肝脂肪变性的检测效果不佳，主要是由于肝纤维化和炎症导致的假阳性结果。
对一家三级医疗胃肠病诊所中感染HCV的患者的超声报告进行回顾性审查。审查报告中关于肝脂肪变性存在的具体记录。记录基线临床和组织学参数，并对有和没有肝脂肪变性的患者进行比较。对这些基线变量进行多因素逻辑回归分析。两名病理学家对肝活检进行审查，并对肝脂肪变性进行分级。将活检中的肝脂肪变性与超声报告中的肝脂肪变性进行比较，并以活检为金标准计算超声检查的性能特征。
有164例患者的超声报告可用。与没有肝脂肪变性的患者相比，超声检查有肝脂肪变性的患者以下参数的发生率更高：糖尿病（12/49 [24%] 对7/115 [6%]，p < 0.001）、纤维化分期>2（15/48 [31%] 对16/110 [15%]，p = 0.02）、组织学分级>2（19/48 [40%] 对17/103 [17%]，p = 0.002）和ALT（129.5±89.0 IU/L对94.3±87.0 IU/L，p = 0.01）。多因素分析显示，组织学分级是与肝脂肪变性独立相关的唯一因素。与肝脂肪变性的组织学诊断（n = 122）相比，超声检查有大量假阳性和假阴性结果。在超声检查正常的患者中，8/82（10%）的活检显示肝脂肪变性>30%。在超声报告有肝脂肪变性的患者中，活检复查时只有12/40（30%）的肝脂肪变性>30%。
在HCV感染患者中，超声检查的肝脂肪变性与炎症和纤维化标志物相关，但在对照研究之外，与活检中的肝脂肪变性并不始终相关。临床医生应怀疑肝超声检查对肝脂肪变性的明确诊断。
