实时剪切波弹性成像评估非酒精性脂肪性肝病脂肪变程度的应用价值

Application value of real-time shear wave elastography for the non-alcoholic fatty liver disease

摘要:

目的：探讨实时剪切波弹性成像（real-time shear wave elastography，SWE）在非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）患者诊断与分期中的应用价值。方法：分别对135例（能够经肝脏穿刺活检或获得肝脏标本证实的）NAFLD患者术前行实时剪切波弹性成像，获得肝脏杨氏模量平均值（Mean），对Mean与病理NAFLD分期进行相关性分析，比较各期NAFLD患者Mean的组间差异，采用ROC曲线评价Mean预测NAFLD的效能。结果：NAFLD不同病理分级间Mean的差异具有统计学意义，随着NAFLD病理级别的增加而增加（P<0.05）；Mean与NAFLD分期呈正相关（rs=0.916，P<0.05）。Mean预测非酒精性脂肪性肝炎曲线下面积为0.971（95%CI=0.949～0.994），敏感度91.3%，特异度97.0%，截点为7.30 kPa。Mean预测非酒精性脂肪性肝纤维化曲线下面积为0.984（95%CI=0.969～0.999），敏感度98.6%，特异度88.7%，截点为9.05 kPa。Mean预测非酒精性脂肪性肝硬化曲线下面积为0.965（95%CI=0.940～0.990），敏感度90.0%，特异度88.5%，截点为11.35 kPa。结论：肝脏实时剪切波弹性成像的Mean可反映NAFLD的严重程度，是NAFLD分期较为敏感的方法，有利于指导临床诊断与治疗。

Abstract:

Objective：To explore the application value of real-time shear wave elastography（SWE） in diagnosing and staging of nonal－coholic fatty liver disease（NAFLD）. Methods：A total of 135 patients diagnosed with nonalcoholic fatty liver disease pathologically or operatively were enrolled to undergo SWE before surgery，and the means of Young’s modulus（Mean） were acquired. The correlation between stages of NAFLD and the Means was analyzed，and the Means of patients at different stages were compared. Finally the receiver operating characteristic（ROC） curve was conducted to evaluate the efficiency of Mean for diagnosing NAFLD at all stages. Results：There were significant differences among Means of NAFLD at different stages（P<0.05），and the Spearman correlation coeffi－cience between Mean and the stage of NAFLD was 0.916（P<0.05）. The area under ROC curve（AUC） of nonalcoholic steatohep－atitis was 0.971（95%CI=0.949 to 0.994），with the sensitivity of 91.3%，the specificity 97.0%，and the threshold value 7.30 kPa. The AUC of fibrosis was 0.984（95%CI=0.969 to 0.999），with the sensitivity of 98.6%，the specificity 88.7%，and the threshold value 9.05 kPa. And the AUC of cirrhosis was 0.965（95%CI=0.940 to 0.990），with the sensitivity of 90.0%，the specificity 88.5%，and the threshold value 11.35 kPa. Conclusion：The Mean of real-time SWE can reflect the severity of NAFLD and is a sensitive indi－cator for NAFLD stages. Consequently it is beneficial to apply SWE in clinical diagnosis and treatment for NAFLD.