评估自身免疫性肝病患者肝脂肪变性的控制衰减参数。
Evaluation of controlled attenuation parameter in assessing hepatic steatosis in patients with autoimmune liver diseases.
机构信息
Department of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200127, China.
Department of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
出版信息
World J Gastroenterol. 2021 Jan 7;27(1):80-91. doi: 10.3748/wjg.v27.i1.80.
BACKGROUND
Hepatic steatosis commonly occurs in some chronic liver diseases and may affect disease progression.
AIM
To investigate the performance of controlled attenuation parameter (CAP) for the diagnosis of hepatic steatosis in patients with autoimmune liver diseases (AILDs).
METHODS
Patients who were suspected of having AILDs and underwent liver biopsy were consistently enrolled. Liver stiffness measurement (LSM) and CAP were performed by transient elastography. The area under the receiver operating characteristic (AUROC) curve was used to evaluate the performance of CAP for diagnosing hepatic steatosis compared with biopsy.
RESULTS
Among 190 patients with biopsy-proven hepatic steatosis, 69 were diagnosed with autoimmune hepatitis (AIH), 18 with primary biliary cholangitis (PBC), and 27 with AIH-PBC overlap syndrome. The AUROCs of CAP for the diagnosis of steatosis in AILDS were 0.878 (0.791-0.965) for S1, 0.764 (0.676-0.853) for S2, and 0.821 (0.716-0.926) for S3. The CAP value was significantly related to hepatic steatosis grade ( < 0.001). Among 69 patients with AIH, the median CAP score was 205.63 ± 47.36 dB/m for S0, 258.41 ± 42.83 dB/m for S1, 293.00 ± 37.18 dB/m for S2, and 313.60 ± 27.89 dB/m for S3. Compared with patients with nonalcoholic fatty liver disease (NAFLD) presenting with autoimmune markers, patients with AIH concomitant with NAFLD were much older and had higher serum IgG levels and LSM values.
CONCLUSION
CAP can be used as a noninvasive diagnostic method to evaluate hepatic steatosis in patients with AILDs. Determination of LSM combined with CAP may help to identify patients with AIH concomitant with NAFLD from those with NAFLD with autoimmune phenomena.
背景
肝脂肪变常见于某些慢性肝病，可能影响疾病进展。
目的
探讨控制衰减参数（CAP）对自身免疫性肝病（AILD）患者肝脂肪变的诊断性能。
方法
连续纳入疑似 AILD 并接受肝活检的患者。通过瞬时弹性成像检测肝硬度测量值（LSM）和 CAP。采用受试者工作特征（ROC）曲线下面积（AUROC）评估 CAP 与活检比较诊断肝脂肪变的性能。
结果
在 190 例经活检证实存在肝脂肪变的患者中，69 例诊断为自身免疫性肝炎（AIH），18 例诊断为原发性胆汁性胆管炎（PBC），27 例诊断为 AIH-PBC 重叠综合征。CAP 诊断 AILD 患者肝脂肪变的 AUROC 为 S1 部位 0.878（0.791-0.965）、S2 部位 0.764（0.676-0.853）、S3 部位 0.821（0.716-0.926）。CAP 值与肝脂肪变程度显著相关（<0.001）。在 69 例 AIH 患者中，S0 部位 CAP 评分中位数为 205.63±47.36dB/m、S1 部位 258.41±42.83dB/m、S2 部位 293.00±37.18dB/m、S3 部位 313.60±27.89dB/m。与伴有自身免疫标志物的非酒精性脂肪性肝病（NAFLD）患者相比，伴有 AIH 的 NAFLD 患者年龄更大，血清 IgG 水平和 LSM 值更高。
结论
CAP 可作为一种无创诊断方法，用于评估 AILD 患者的肝脂肪变。LSM 联合 CAP 测定有助于从伴有自身免疫现象的 NAFLD 患者中识别出伴有 AIH 的 NAFLD 患者。
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