受控衰减参数在非侵入性评估肝脂肪变性中的临床价值。
The clinical value of controlled attenuation parameter for the noninvasive assessment of liver steatosis.
机构信息
Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
出版信息
Liver Int. 2016 Dec;36(12):1860-1866. doi: 10.1111/liv.13207. Epub 2016 Aug 6.
BACKGROUND & AIMS: Ultrasound is the imaging modality most widely utilized in the general population for diagnostic purposes. Controlled attenuation parameter is a novel noninvasive method for assessing steatosis. Our aim was to investigate whether the clinical value of controlled attenuation parameter in patients referred for abdominal ultrasound examinations is affected by liver fibrosis.
METHODS
Consecutive patients referred for abdominal ultrasound examinations were enrolled. Controlled attenuation parameter and liver stiffness were assessed with the FibroScan (Echosens, France). Liver fibrosis was staged according to published cutoffs of liver stiffness measurements. Pearson's or Spearman's rank correlation coefficient was used to test the association between two study variables. Optimal cutoff of controlled attenuation parameter for diagnosing liver steatosis (S≥2) was 256 dB/m. The diagnostic performance and accuracy of dichotomized controlled attenuation parameter, ultrasound and body mass index were analysed using the imperfect gold standard methodology.
RESULTS
A total of 726 subjects (464 males and 262 females) were studied. Five hundred and eight-nine (81.1%) patients were affected by chronic viral hepatitis. Correlation of controlled attenuation parameter with ultrasound score was 0.48 and 0.57 in patients with and without chronic viral hepatitis respectively. In patients with chronic viral hepatitis, ultrasound, dichotomized controlled attenuation parameter and body mass index showed performance of 58.2%, 82.3% and 46.7%, respectively, whereas in patients without chronic viral hepatitis, the performance was 86.4%, 68.6% and 48.6% respectively.
CONCLUSIONS
In patients with chronic viral hepatitis and advanced liver fibrosis, controlled attenuation parameter performs better than ultrasound for assessing liver steatosis, whereas in patients without viral hepatitis and with nonsignificant liver disease ultrasound shows the best performance.
背景与目的
超声是最广泛应用于普通人群进行诊断的影像学方式。受控衰减参数是一种新型的非侵入性方法，用于评估脂肪变性。我们的目的是研究在接受腹部超声检查的患者中，受控衰减参数的临床价值是否受肝纤维化的影响。
方法
连续纳入接受腹部超声检查的患者。使用 FibroScan（Echosens，法国）评估受控衰减参数和肝硬度。根据肝硬度测量的公布截断值对肝纤维化进行分期。使用 Pearson 或 Spearman 等级相关系数检验两个研究变量之间的相关性。用于诊断肝脂肪变性（S≥2）的受控衰减参数最佳截断值为 256 dB/m。使用不完美金标准方法分析二分类受控衰减参数、超声和体重指数的诊断性能和准确性。
结果
共纳入 726 例患者（464 例男性和 262 例女性）。508 例（81.1%）患者患有慢性病毒性肝炎。在患有和不患有慢性病毒性肝炎的患者中，受控衰减参数与超声评分的相关性分别为 0.48 和 0.57。在患有慢性病毒性肝炎的患者中，超声、二分类受控衰减参数和体重指数的表现分别为 58.2%、82.3%和 46.7%，而在不患有慢性病毒性肝炎的患者中，表现分别为 86.4%、68.6%和 48.6%。
结论
在患有慢性病毒性肝炎和晚期肝纤维化的患者中，受控衰减参数在评估肝脂肪变性方面优于超声，而在没有病毒性肝炎且肝脏疾病不显著的患者中，超声表现最佳。
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