肝脂肪变指数、受控衰减参数与超声在慢性乙型肝炎肝脂肪变无创诊断中的比较。

A comparison of hepatic steatosis index, controlled attenuation parameter and ultrasound as noninvasive diagnostic tools for steatosis in chronic hepatitis B.

机构信息

First Center for Clinical College, Tianjin Medical University, Tianjin, China; Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China; Tianjin Research Institute of Liver Diseases, Tianjin, China.

First Center for Clinical College, Tianjin Medical University, Tianjin, China; Tianjin First Center Hospital, Tianjin, China; Tianjin Research Institute of Liver Diseases, Tianjin, China.

出版信息

Dig Liver Dis. 2017 Aug;49(8):910-917. doi: 10.1016/j.dld.2017.03.013. Epub 2017 Mar 30.

DOI:10.1016/j.dld.2017.03.013

PMID:28433586

Abstract

AIMS

To evaluate the value of noninvasive tools for diagnosis of hepatic steatosis in patients with chronic hepatitis B (CHB).

METHODS

Consecutive treatment-naïve patients with CHB with body mass index less than 30kg/m who underwent liver biopsy, ultrasound and FibroScan were enrolled. The diagnostic performance of controlled attenuation parameter (CAP), hepatic steatosis index (HSI) and ultrasound for hepatic steatosis compared with liver biopsy was assessed. The areas under receiver operating characteristics curves (AUROCs) were calculated to determine the diagnostic efficacy, with comparisons using the DeLong test.

RESULTS

CAP and HSI accuracies were significantly higher than that of ultrasound to detect patients with biopsy-proven mild steatosis (S1, 65.3%, 56.5%, respectively, vs. 17.7%, χ=46.305, 31.736, both P<0.05)and moderate-severe (S2-3) steatosis (92.3%, 100%, respectively, vs. 53.8%, χ=4.887, 7.800, P=0.037, 0.007, respectively). Both CAP and HSI had lower underestimation rates of steatosis grade than ultrasound (12%, 14.8%, respectively, vs. 29.5%, χ=9.765, 6.452; P<0.05 for both), but they exhibited higher overestimation rates (30.5%, 38.2%, respectively, vs. 12.4%, χ=39.222, 70.986; both P<0.05). The AUROCs of CAP and HSI were 0.780 (95% confidence intervals [CIs] 0.735-0.822) and 0.655 (95%CI 0.604-0.704) for S ≥1, 0.932 (95%CI 0.902-0.956) and 0.755 (95%CI 0.707-0.799) for S ≥2, 0.990 (95%CI 0.974-0.998) and 0.786 (95% CI 0.740-0.827) for S3, respectively.

CONCLUSION

CAP might be more accurate for detecting hepatic steatosis than HSI and ultrasound in patients with CHB, but further studies are needed to reduce the overestimation rates.

摘要

目的

评估无创工具在诊断慢性乙型肝炎（CHB）患者肝脂肪变中的价值。

方法

连续纳入了接受肝活检、超声和 FibroScan 检查且体重指数（BMI）<30kg/m²的初治 CHB 患者。评估受控衰减参数（CAP）、肝脂肪变指数（HSI）和超声对肝脂肪变的诊断性能，并与肝活检进行比较。计算受试者工作特征曲线下面积（AUROCs）以确定诊断效能，并采用 DeLong 检验进行比较。

结果

CAP 和 HSI 诊断肝活检证实的轻度脂肪变（S1）和中重度脂肪变（S2-3）的准确率明显高于超声（65.3%、56.5%，分别，vs. 17.7%，χ=46.305，31.736，均 P<0.05）。CAP 和 HSI 对肝脂肪变程度的低估率均低于超声（12%、14.8%，分别，vs. 29.5%，χ=9.765，6.452；均 P<0.05），但高估率均高于超声（30.5%、38.2%，分别，vs. 12.4%，χ=39.222，70.986；均 P<0.05）。CAP 和 HSI 诊断 S≥1 的 AUROCs 分别为 0.780（95%置信区间 [CI] 0.735-0.822）和 0.655（95%CI 0.604-0.704），诊断 S≥2 的 AUROCs 分别为 0.932（95%CI 0.902-0.956）和 0.755（95%CI 0.707-0.799），诊断 S3 的 AUROCs 分别为 0.990（95%CI 0.974-0.998）和 0.786（95%CI 0.740-0.827）。