受控衰减参数检测慢性肝病患者肝脂肪变性的诊断准确性
Diagnostic Accuracy of Controlled Attenuation Parameter for Detecting Hepatic Steatosis in Patients with Chronic Liver Disease.
作者信息
Andrade Patrícia, Rodrigues Susana, Rodrigues-Pinto Eduardo, Gaspar Rui, Lopes Joanne, Lopes Susana, Macedo Guilherme
机构信息
Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, University of Porto, Porto, Portugal.
Department of Pathology, Faculty of Medicine, Centro Hospitalar São João, University of Porto, Porto, Portugal.
出版信息
GE Port J Gastroenterol. 2017 Jul;24(4):161-168. doi: 10.1159/000453364. Epub 2016 Dec 23.
INTRODUCTION
Controlled attenuation parameter (CAP), measured by transient elastography, has been suggested as a noninvasive method for the detection and quantification of steatosis. We aimed to assess the accuracy of CAP to detect steatosis in patients with chronic liver disease (CLD) compared with liver histology and to evaluate factors that correlate with the CAP value.
METHODS
Patients with CLD who underwent liver biopsy and simultaneous CAP determination were consecutively enrolled. CAP was measured using the M probe of FibroScan® (Echosens, Paris, France). Histologically, steatosis was categorized as absent (S0: <5%), mild (S1: 5-33%), moderate (S2: 34-66%) and severe (S3: >66% of all hepatocytes).
RESULTS
We analyzed 159 patients with CLD (61% men, mean age 47.9 ± 12.9 years). We found a positive correlation between CAP and steatosis in histology ( = 0.869, < 0.001), arterial hypertension ( = 0.222, = 0.005), type 2 diabetes mellitus ( = 0.279, < 0.001), body mass index (BMI; = 0.533, < 0.001), total cholesterol ( = 0.442, < 0.001), triglycerides ( = 0.272, = 0.001), and non-alcoholic fatty liver disease (NAFLD; = 0.588, < 0.001). In the multivariate analysis, BMI >25 (odds ratio [OR] 48.4, 95% confidence interval [CI] 23.78-72.95, < 0.001), serum total cholesterol (OR 3.803, 95% CI 2.203-13.889, = 0.008), and NAFLD etiology (OR 40.8, 95% CI 15.01-66.66, = 0.002) were independently associated with higher CAP values. We did not find any significant correlation between CAP and the grade of necroinflammatory activity ( = 0.063, = 0.808) or fibrosis ( = 0.071, = 0.713) in histology and with alanine aminotransferase ( = 0.190, = 0.356) or aspartate aminotransferase ( = 0.117, = 0.142). Optimal CAP cutoff values for detecting steatosis ≥S1, ≥S2, and ≥S3 were 206.5, 232.5, and 282.5 dB/m, respectively. CAP performance was 0.822, 0.956, and 0.976 for diagnosing steatosis ≥S1, ≥S2, and ≥S3, respectively.
CONCLUSIONS
CAP had an excellent diagnostic accuracy for the detection of steatosis in diverse CLD patients. A CAP value cutoff of <282.5 dB/m excludes severe steatosis ≥S3 with an accuracy of 98%.
引言
通过瞬时弹性成像测量的受控衰减参数（CAP）已被认为是一种用于检测和量化脂肪变性的非侵入性方法。我们旨在评估与肝脏组织学相比，CAP检测慢性肝病（CLD）患者脂肪变性的准确性，并评估与CAP值相关的因素。
方法
连续纳入接受肝活检并同时测定CAP的CLD患者。使用FibroScan®（法国巴黎Echosens公司）的M探头测量CAP。组织学上，脂肪变性分为无（S0：<5%）、轻度（S1：5-33%）、中度（S2：34-66%）和重度（S3：所有肝细胞的>66%）。
结果
我们分析了159例CLD患者（61%为男性，平均年龄47.9±12.9岁）。我们发现CAP与组织学上的脂肪变性（r = 0.869，P < 0.001）、动脉高血压（r = 0.222，P = 0.005）、2型糖尿病（r = 0.279，P < 0.001）、体重指数（BMI；r = 0.533，P < 0.001）、总胆固醇（r = 0.442，P < 0.001）、甘油三酯（r = 0.272，P = 0.001）和非酒精性脂肪性肝病（NAFLD；r = 0.588，P < 0.001）呈正相关。在多变量分析中，BMI>25（比值比[OR] 48.4，95%置信区间[CI] 23.78-72.95，P < 0.001）、血清总胆固醇（OR 3.803，95% CI 2.203-13.889，P = 0.008）和NAFLD病因（OR 40.8，95% CI 15.01-66.66，P = 0.002）与较高的CAP值独立相关。我们未发现CAP与组织学上的坏死性炎症活动分级（r = 0.063，P = 0.808）或纤维化（r = 0.071，P = 0.713）以及丙氨酸氨基转移酶（r = 0.190，P = 0.356）或天冬氨酸氨基转移酶（r = 0.117，P = 0.142）之间存在任何显著相关性。检测脂肪变性≥S1、≥S2和≥S3的最佳CAP临界值分别为206.5、232.5和282.5 dB/m。CAP诊断脂肪变性≥S1、≥S2和≥S3的性能分别为0.822、0.956和0.976。
结论
CAP对不同CLD患者脂肪变性的检测具有出色的诊断准确性。CAP值临界值<282.5 dB/m可排除重度脂肪变性≥S3，准确性为98%。
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