FibroTouch联合超声和CT检查诊断高原地区非酒精性脂肪性肝病临床应用研究*

目的 评价FibroTouch(FT)联合超声和CT检查诊断青海高原地区非酒精性脂肪性肝病(NAFLD)患者的临床应用价值。方法 2018年8月～2019年5月青海省人民医院消化科住院的非酒精性脂肪性肝病患者343例,所有人员同时接受FT、腹部超声和腹部CT检查,分析任意检查对NAFLD的检出率,并分析FT相对于腹部超声和CT诊断NAFLD的灵敏度、特异度和受试者工作特征曲线下面积(AUROC),以Kappa值评价FT与这两种方法诊断的一致性,分析FT单独和联合这两种方法诊断NAFLD的检出率。结果 FT诊断本组人群NAFLD的检出率为63.9%,腹部超声诊断检出率为40.2%,腹部CT检出率为26.2%;相对于腹部超声诊断NAFLD,FT检查的灵敏度为82.6%,特异度为48.8%,AUROC为0.657(95%CI:0.610～0.704);相对于腹部CT诊断NAFLD,FT检查诊断的灵敏度为88.9%,特异度为45.1%,AUROC为0.670(95%CI:0.624～0.715);FT检查与腹部超声检查诊断NAFLD的总体一致性为62.4%,Kappa系数为0.29,说明两者诊断的一致性较差;FT检查与腹部CT检查诊断的总体一致性为56.6%,Kappa系数为0.23,两者诊断的一致性也较差;三者联合检查均诊断为NAFLD患者247例,其中FT检查、腹部超声和腹部CT检查的单独检出率分别为88.7%、55.9%和36.4%,联合FibroTouch和腹部超声诊断或联合FT和腹部CT诊断将检出率分别提高到98.4%和92.7%。结论 使用FT检查、腹部超声和腹部CT检查诊断NAFLD的一致性较差,联合FT和腹部超声诊断、联合FT和腹部CT诊断能进一步提高高原地区人群NAFLD的检出率。

Clinical application of FibroTouchand abdominal color ultrasound and computed tomography in diagnosis of individuals with nonalcoholic fatty liver disease in plateau regions

Objective The aim of this study was to evaluate the clinical application of FibroTouch (FT) in combination with abdominal color ultrasound and computed tomography (CT) in diagnosis of individuals with nonalcoholic fatty liver disease in plateau regions. Methods A total of 343 persons with nonalcoholic fatty liver disease (NAFLD) were enrolled in the Department of Gastroenterology in the Qinghai Provincial People's Hospital between August 2018 and May 2019. The NAFLD was diagnosed by the examination of FT, abdominal color ultrasound, or CT. The diagnostic sensitivity, consistency, and diagnosis rate of FT relative to ultrasound or CT examination were analyzed by AUROC and Kappa value. Results The diagnosed rate of NAFLD by FT, ultrasound and CT examination were 63.9%, 40.2% and 26.2%, respectively, in our series; the diagnosis sensitivity and specificity of FT relative to ultrasoundex amination were 82.6% and 48.8% (AUROC=0.657, 95% CI: 0.610-0.704), and those relative to CT examination were 88.9% and 45.1% (AUROC=0.670, 95% CI: 0.624-0.715); the diagnostic results of FT had a lower consistency with both ultrasound or CT diagnosis by 62.4% (Kappa coefficient = 0.29) and 56.6% (Kappa coefficient = 0.23) ,respectively; the diagnostic rates of FT, ultrasound and CT examination were 88.7%, 55.9% and 36.3%, respectively; the diagnostic rates were raised to 98.4% and 92.7 when the FT combined with ultrasound examination or CT examination, respectively. Conclusions There is a lower consistency between FT and ultrasound or CT examination in diagnosis of NAFLD, while the diagnostic rate of NAFLD could be improved by FT combined with ultrasound or CT examination in persons in plateau regions.