Paul Jayanta, Venugopal Raj Vigna, Peter Lorance, Shetty Kula Naresh Kumar, Shetti Mohit P
Department of Gastroenterology, Manipal Hospital, Bangalore, India.
Arq Gastroenterol. 2018 Jan-Mar;55(1):7-13. doi: 10.1590/S0004-2803.201800000-07.
Liver biopsy is a gold standard method for hepatic steatosis assessment. However, liver biopsy is an invasive and painful procedure and can cause severe complications therefore it cannot be frequently used in case of follow-up of patients. Non-invasive assessment of steatosis and fibrosis is of growing relevance in non-alcoholic fatty liver disease (NAFLD). To evaluate hepatic steatosis, transient elastography with controlled attenuation parameter (CAP) measurement is an option now days.
Aim of this study is to evaluate role of measurement of controlled attenuation parameter, a surrogate marker of hepatic steatosis in patients of nonalcoholic fatty liver disease on lifestyle modification.
In this study, initially 37 participants were included who were followed up after 6 months with transient elastography, blood biochemical tests and anthropometric measurements. The results were analyzed by Multivariate linear regression analysis and paired samples t-test (Dependent t-test) with 95% confidence interval. Correlation is calculated by Pearson correlation coefficients.
Mean CAP value for assessing hepatic steatosis during 1st consultation (278.57±49.13 dB/m) was significantly improved (P=0.03) after 6 months of lifestyle modification (252.91±62.02 dB/m). Only fasting blood sugar (P=0.008), weight (P=0.000), body mass index (BMI) (P=0.000) showed significant positive correlation with CAP. Only BMI (P=0.034) and weight (P=0.035) were the independent predictor of CAP value in NAFLD patients.
Lifestyle modification improves the hepatic steatosis, and CAP can be used to detect the improvement of hepatic steatosis during follow-up in patients with NAFLD on lifestyle modification. There is no relation between CAP and Fibroscan score in NAFLD patients. Only BMI and weight can predict CAP value independently.
肝活检是评估肝脂肪变性的金标准方法。然而，肝活检是一种侵入性且痛苦的操作，可能导致严重并发症，因此在患者随访中不能频繁使用。非酒精性脂肪性肝病（NAFLD）中，对脂肪变性和纤维化的非侵入性评估越来越重要。如今，采用受控衰减参数（CAP）测量的瞬时弹性成像技术是评估肝脂肪变性的一种选择。
本研究旨在评估受控衰减参数测量在非酒精性脂肪性肝病患者生活方式改变时作为肝脂肪变性替代标志物的作用。
本研究最初纳入37名参与者，在6个月后通过瞬时弹性成像、血液生化检查和人体测量进行随访。结果采用多变量线性回归分析和配对样本t检验（相关t检验）进行分析，置信区间为95%。相关性通过Pearson相关系数计算。
首次就诊时评估肝脂肪变性的平均CAP值为（278.57±49.13 dB/m），在生活方式改变6个月后显著改善（P = 0.03），变为（252.91±62.02 dB/m）。仅空腹血糖（P = 0.008）、体重（P = 0.000）、体重指数（BMI）（P = 0.000）与CAP呈显著正相关。在NAFLD患者中，仅BMI（P = 0.034）和体重（P = 0.035）是CAP值的独立预测因素。
生活方式改变可改善肝脂肪变性，CAP可用于检测NAFLD患者生活方式改变随访期间肝脂肪变性的改善情况。NAFLD患者中CAP与Fibroscan评分无关。仅BMI和体重可独立预测CAP值。
