Zenovia Sebastian, Stanciu Carol, Sfarti Catalin, Singeap Ana-Maria, Cojocariu Camelia, Girleanu Irina, Dimache Mihaela, Chiriac Stefan, Muzica Cristina Maria, Nastasa Robert, Huiban Laura, Cuciureanu Tudor, Trifan Anca
Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.
St. Spiridon Emergency Hospital, 700115 Iasi, Romania.
Diagnostics (Basel). 2021 Apr 27;11(5):787. doi: 10.3390/diagnostics11050787.
Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is a widely used non-invasive technique for concomitant assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the level both of hepatic steatosis and fibrosis as well as the associated risk factors in patients referred to our unit with clinically suspected NAFLD or diagnosed by abdominal ultrasonography. Two hundred four patients were prospectively included in this study and assessed by VCTE with CAP. The final analysis included 181 patients with reliable liver stiffness measurements (LSMs) (53% female, mean age 57.62 ± 11.8 years and BMI 29.48 ± 4.85 kg/m). According to the cut-off values for steatosis grading, there were 10 (5.5%) patients without steatosis (S0), 30 (16.6%) with mild (S1), 45 (24.9%) moderate (S2), and 96 (53%) severe (S3) steatosis. Based on LSM, there were 73 (40.3%) patients without fibrosis (F0), 42 (23.2%) with mild (F1), 32 (17.7%) significant (F2), 19 (10.5%) advanced (F3) fibrosis, and 15 (8.3%) with cirrhosis (F4). In addition, we found an association between several metabolic components and hepatic steatosis and fibrosis. Thus, in the multivariate analysis, higher BMI, fasting plasma glucose, triglycerides, low-density lipoprotein cholesterol, and serum uric were associated with increased CAP. Furthermore, higher serum uric acid and alpha-fetoprotein together with lower platelets count and albumin levels were associated with increased LSM. The assessment of steatosis and fibrosis using VCTE and CAP should be performed in all patients with suspected or previously diagnosed NAFLD in units with available facilities.
具有受控衰减参数（CAP）的振动控制瞬时弹性成像（VCTE）是一种广泛应用的非侵入性技术，用于同时评估非酒精性脂肪性肝病（NAFLD）患者的肝脏脂肪变性和纤维化。我们旨在评估因临床怀疑NAFLD或经腹部超声诊断而转诊至我科的患者的肝脏脂肪变性和纤维化水平以及相关危险因素。本研究前瞻性纳入了204例患者，并采用VCTE结合CAP进行评估。最终分析纳入了181例肝脏硬度测量值（LSM）可靠的患者（女性占53%，平均年龄57.62±11.8岁，体重指数29.48±4.85kg/m）。根据脂肪变性分级的临界值，无脂肪变性（S0）的患者有10例（5.5%），轻度（S1）的有30例（16.6%），中度（S2）的有45例（24.9%），重度（S3）的有96例（53%）。基于LSM，无纤维化（F0）的患者有73例（40.3%），轻度（F1）的有42例（23.2%），显著（F2）的有32例（17.7%），进展期（F3）的有19例（10.5%），肝硬化（F4）的有15例（8.3%）。此外，我们发现几种代谢成分与肝脏脂肪变性和纤维化之间存在关联。因此，在多变量分析中，较高的体重指数、空腹血糖、甘油三酯、低密度脂蛋白胆固醇和血清尿酸与CAP升高有关。此外，较高的血清尿酸和甲胎蛋白，以及较低的血小板计数和白蛋白水平与LSM升高有关。对于所有疑似或先前诊断为NAFLD且所在科室具备可用设备的患者，均应采用VCTE和CAP对脂肪变性和纤维化进行评估。
