声辐射力脉冲技术联合肝功能及血脂指标在非酒精性脂肪性肝病风险预测中的应用

目的 探讨声辐射力脉冲成像 (ARFI)中声触诊组织量化(VTQ)技术联合肝功能及血脂指标在非酒精性脂肪性肝病(NAFLD)风险预测中的临床诊断价值。方法 回顾性分析 2016年9月—2017年12月在马鞍山市人民医院,行弹性超声检查、多层螺旋CT(MSCT)检查及实验室检查的189例住院患者临床资料, 以2010年《非酒精性脂肪性肝病诊疗指南》为指导,结合MSCT检查结果,将研究对象分成非肝病组[61例,男36例,女25例,年龄41~68(57±14)岁]和NAFLD组[128例,男61例,女67例,年龄37~71(60±14 )岁]。分析VTQ、肝功能及血脂指标在非肝病组与NAFLD组之间的差异。依据logistic回归独立因素的回归系数绘制列线图模型,并采用Bootstrap自抽样方法对列线图模型进行内部验证,构建预测NAFLD的风险评估模型。结果 NAFLD组与对照组年龄、性别差异均无统计学意义(P值均＜0.05)。NAFLD组的肝VTQ、肝脾VTQ的比值、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和三酰甘油(TG)均高于对照组,而高密度脂蛋白(HDL)低于对照组(P值均＜0.05);其余变量均无统计学差异(P值均＞0.05)。多因素logistic回归结果表明,肝VTQ (OR=8.054, 95%CI 2.117~30.639)、ALT(OR=1.037, 95%CI 1.007~1.068)和TG (OR 1.500,95%CI 1.042~2.159) 为NAFLD的独立危险因素(P值均＜0.05)。肝VTQ、ALT和TG作为因变量构建列线图,一致性系数为0.763。结论 VTQ作为一种无创性检查方法,可有效诊断NAFLD。 肝VTQ技术联合血清ALT和TG化验检查能较准确地预测患者发生NAFLD的风险值。

Application of acoustic impulse radiation force technology combined with liver function and blood lipid in risk prediction of nonalcoholic fatty liver disease

Objective To discuss the clinical value of virtual touch tissues quantification (VTQ) technique combined with indicators of liver function and blood lipid levels in risk prediction for non-alcoholic fatty liver disease (NAFLD) in acoustic radiation force impulse (ARFI).Methods A total of 189 inpatients with elastography, multi-slice spiral CT (MSCT) and laboratory tests at the People's Hospital of Ma'anshan from September 2016 to December 2016 were selected. Inclusion/exclusion criteria was guided by the 2010 Guidelines for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Diseases and the Results of MSCT. The study objects were divided into non-liver disease group and NAFLD group. Differences of VTQ, liver function and blood lipid indicators were analyzed and compared between control group and NAFLD group. Independent factors of Logistic regression coefficient were used to build nomogram model (with Bootstrap self-sampling for internal verification) to evaluate the risk of NAFLD.Results There were no statistical differences in age and sex between NAFLD group and non-liver disease group. The ratio of liver VTQ, liver/spleen VTQ, alanine transaminase(ALT), aspartate aminotransferase (AST) and triacylglycerol (TG) in NAFLD group were higher than those in non-liver disease group, but HDL was lower than that in non-liver disease group (all P values＜0.05). Remaining variables had no differences in statistics (all P values＞0.05). Multivariate logistic regression analysis had shown that liver VTQ (OR=8.054, 95%CI 2.117-30.639), ALT (OR=1.037, 95%CI 1.007-1.068) and TG (OR=1.500, 95%CI 1.042-2.159) were independent risk factors for NAFLD (all P values＜0.05). The nomogram was constructed with liver VTQ, ALT and TG as dependent variables and the C-index was 0.763.Conclusions VTQ as a noninvasive examination method can effectively diagnose NAFLD. Liver VTQ combined with ALT and TG can accurately provide risk value for NAFLD.