Ferraioli Giovanna, Tinelli Carmine, Lissandrin Raffaella, Zicchetti Mabel, Dal Bello Barbara, Filice Gaetano, Filice Carlo
Giovanna Ferraioli, Raffaella Lissandrin, Mabel Zicchetti, Gaetano Filice, Carlo Filice, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, 27100 Pavia, Italy.
World J Gastroenterol. 2014 Jun 7;20(21):6626-31. doi: 10.3748/wjg.v20.i21.6626.
To assess the performance of controlled attenuation parameter (CAP) in patients with chronic viral hepatitis.
CAP is a new technique that measures the attenuation in the liver of an ultrasound beam, which is directly related to lipid accumulation. Consecutive patients undergoing liver biopsy for chronic viral hepatitis were studied using the M probe of FibroScan device (Echosens, Paris, France). The device estimates liver steatosis in decibel per meter (dB/m). An expert operator performed all measurements. Steatosis was graded according to Kleiner's classification. Pearson or Spearman rank coefficient was used to test correlation between two study variables. Linear regression was used for multivariate model to assess the association between CAP and other variables. Receiver operating characteristic curve analysis was performed to calculate area under the curve (AUROC) for S0 vs S1-S3 and S0-S1 vs S2-S3.
115 subjects (85 males and 30 females) were prospectively studied. The mean values of CAP were 227.1 ± 43.1 for S0; 254.6 ± 38.9 for S1; 297.8 ± 49.4 dB/m for S2-S3. In univariate analysis CAP showed a significant correlation with age, body mass index (BMI), degree of steatosis, and cholesterol. Multivariate regression analysis confirmed the correlation with the degree of steatosis [coefficient, 1.2 (0.60-1.83); P < 10(-5)] and BMI [coefficient, 4.1 (0.5-7.8); P = 0.03] but not with all other variables. Optimal cutoff values for S ≥ 1 and S ≥ 2 were 219 dB/m [AUROC, 0.76 (0.67-0.84); sensitivity, 91.1% (78.8-97.5); specificity, 51.6% (38.7-64.2); positive predictive value, 56.9% (44.7-68.6); negative predictive value, 89.2% (74.3-97.0); positive likelihood ratio, 1.88 (1.4-2.5); negative likelihood ratio, 0.17 (0.07-0.5)] and 296 dB/m [AUROC, 0.82 (0.74-0.89); sensitivity, 60.0% (32.3-83.7); specificity, 91.5% (83.9-96.3); positive predictive value, 52.9% (27.8-77.0); negative predictive value, 93.5% (86.3-97.6); positive likelihood ratio, 7.05 (3.2-15.4); negative likelihood ratio, 0.44 (0.2-0.8)], respectively.
Controlled attenuation parameter could be a useful tool in the clinical management of patients with chronic viral hepatitis for detecting liver steatosis.
评估受控衰减参数（CAP）在慢性病毒性肝炎患者中的表现。
CAP是一种测量超声束在肝脏中衰减的新技术，其与脂质蓄积直接相关。使用FibroScan设备（法国巴黎Echosens公司）的M探头对连续接受肝活检的慢性病毒性肝炎患者进行研究。该设备以分贝每米（dB/m）为单位估算肝脏脂肪变性程度。所有测量均由专业操作人员进行。根据克莱纳分类法对脂肪变性进行分级。采用Pearson或Spearman等级系数检验两个研究变量之间的相关性。使用线性回归建立多变量模型，以评估CAP与其他变量之间的关联。绘制受试者工作特征曲线进行分析，计算S0与S1 - S3以及S0 - S1与S2 - S3的曲线下面积（AUROC）。
前瞻性研究了115名受试者（85名男性和30名女性）。S0组CAP的平均值为227.1±43.1；S1组为254.6±38.9；S2 - S3组为297.8±49.4 dB/m。单因素分析显示，CAP与年龄、体重指数（BMI）、脂肪变性程度和胆固醇显著相关。多变量回归分析证实CAP与脂肪变性程度[系数，1.2（0.60 - 1.83）；P < 10⁻⁵]和BMI[系数，4.1（0.5 - 7.8）；P = 0.03]相关，但与其他变量无关。S≥1和S≥2的最佳截断值分别为219 dB/m[AUROC，0.76（0.67 - 0.84）；敏感度，91.1%（78.8 - 97.5）；特异度，51.6%（38.7 - 64.2）；阳性预测值，56.9%（44.7 - 68.6）；阴性预测值，89.2%（74.3 - 97.0）；阳性似然比，1.88（1.4 - 2.5）；阴性似然比，0.17（0.07 - 0.5）]和296 dB/m[AUROC，0.82（0.74 - 0.89）；敏感度，60.0%（32.3 - 83.7）；特异度，91.5%（83.9 - 96.3）；阳性预测值，52.9%（27.8 - 77.0）；阴性预测值，93.5%（86.3 - 97.6）；阳性似然比，7.05（3.2 - 15.4）；阴性似然比，0.44（0.2 - 0.8）]。
受控衰减参数可能是慢性病毒性肝炎患者临床管理中检测肝脏脂肪变性的有用工具。
