FibroTouch检测肝脏受控衰减参数对肝脂肪变的诊断价值分析*

目的 探讨FibroTouch定量检测肝脂肪变受控衰减参数（CAP）诊断肝脏脂肪变程度的价值。方法 2016年8月~2017年10月纳入脂肪肝可疑人群63例,行FibroTouch检测和肝活检检查。采用多元线性回归分析,建立回归方程,构建受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,确定CAP值的诊断效能和影响因素。结果 经肝组织学检查,诊断为S0者36例（57.1%）,NAFLD人群27例,其中S1者12例（19.1%）,S2者9例（14.3%）,S3者6例（9.5%）;其CAP值分别为（200.2±21.2） dB/m、（228.7±51.7） dB/m、（259.4±29.1） dB/m和（320.5±22.4） dB/m;CAP与BMI（r=0.503,P=0.000）、肝细胞脂肪变性程度（r=0.761,P=0.000）呈显著正相关;BMI和肝脂肪变程度为CAP值的独立预测因素;CAP值诊断肝脏脂肪变S1、S2和S3的截断点分别为212 dB/m、246 dB/m和287 dB/m,其敏感度分别为81.5%、86.7%和100.0%,特异度分别为80.6%、91.7%和96.5%。结论 FibroTouch可以有效而准确地诊断和评估肝脏脂肪变性程度,值得进一步研究。

Value of controlled attenuation parameter in diagnosis of individuals with liver steatosis by using Fibrotouch

Objective To investigate the value of controlled attenuation parameter （CAP） in diagnosis of individuals with liver steatosis （S） by using Fibrotouch in comparison to liver biopsy.Methods 63 suspected individuals with liver steatosis were enrolled in this study,and all of them received liver biopsies and Fibrotouch measurement for CAP within 2 weeks after liver biopsy. Multiple stepwise regression analysis was used to identify the influencing factors of CAP and establish regressive equation. The receiver operating characteristic（ROC） and the area under ROC（AUROC） were calculated to determine the optimal cut-off value of CAP for diagnosis of liver steatosis.Results Based on liver histopathological examination,the S0 was found in 36（57.1%） and individuals with NAFLD in 27;out of them,we demonstrated S1 in 12（19.1%）,S2 in 9（14.3%） and S3 in 6（9.5%）,with the CAP of （200.2±21.2） dB/m,（228.7±51.7） dB/m,（259.4±29.1） dB/m and （320.5±22.4） dB/m,respectively;the CAP in individuals with NAFLD was positively correlated to body mass index （BMI,r=0.503,P=0.000） and liver steatosis（r=0.761,P=0.000）,and BMI and liver steatosis were the independent predicting factors for CAP;the cut-off-value of CAP in diagnosing S1,S2 and S3 were 212 dB/m,246 dB/m and 287 dB/m,with the sensitivity of 81.5%,86.7% and 100.0% and specificity of 80.6%,91.7% and 96.5%,respectively. Conclusion FibroTouch measurement might help diagnose liver steatosis with high efficacy,which warrants further investigation.