高频超声所测肝脾指数对非酒精性脂肪肝分级诊断的多中心研究

目的 应用高频超声测量肝脾指数（HSI）,探讨其在非酒精性脂肪肝（NAFLD）分级诊断中的临床价值。方法 回顾性纳入全国5所医院共233例肝脏疾病患者,均经手术或肝脏穿刺获得脂肪肝病理学分级,并根据病理结果将研究对象分为正常组27例、轻度组77例、中度组83例、重度组46例。所有患者均于获得病理结果前14 d内进行超声检查,获得肝脏与脾脏平均灰度值比值即为HSI;收集患者临床资料,比较各组上述参数的差异。采用多元线性回归分析HSI与各临床资料及脂肪变性程度的相关性;绘制受试者工作特征（ROC）曲线分析HSI对不同程度肝脏脂肪变性的诊断效能。结果 轻度、中度、重度组与正常组年龄、谷草转氨酶（AST）、白蛋白（ALB）、总胆固醇（TC）、低密度脂蛋白（LDL）、甘油三酯（TG）比较,差异均有统计学意义（均P＜0.05）。正常组、轻度组、中度组、重度组HSI分别为1.04±0.09、1.11±0.14、1.22±0.13、1.33±0.17,各组比较差异有统计学意义（P＜0.05）;其中重度组HSI最高,中度组、轻度组次之,正常组最低,各组两两比较差异均有统计学意义（均P＜0.05）。相关性分析显示,HSI与脂肪变性程度呈线性正相关（β=0.115,t=22.824,P＜0.001）。ROC曲线分析显示,HSI诊断有无肝脏脂肪变性、中度以上肝脏脂肪变性、重度肝脏脂肪变性的曲线下面积分别为0.84（95%可信区间： 0.76~0.91）、0.86（95%可信区间：0.81~0.91）、0.80（95%可信区间：0.72~0.88）,截断值分别为1.13、1.16、1.24,灵敏度和特异度分别为60.2%和92.3%、82.0%和92.4%、78.3%和86.6%。结论 高频超声所测HSI在NAFLD分级诊断中有重要的的临床价值。

Multicenter Study on High-Frequency Ultrasound Measurement of Hepatosplenic Index for Grading Diagnosis of Non-Alcoholic Fatty Liver Disease

Objective To explore the clinical value of high-frequency ultrasound Hepatosplenic Index （HSI） in the grading diagnosis of non-alcoholic fatty liver （NALFD）. Methods Retrospectively, 233 patients with liver disease from five hospitals nationwide were included, all of whom underwent surgery or liver biopsy to obtain pathological grading of fatty liver. Based on the pathological results, the study classified the subjects into the normal group(27 cases), mild group(77 cases), moderate group(83 cases), and severe group(46 cases).All patients underwent ultrasound examination within 14 days before obtaining the pathological results, and the ratio of the average gray values of the liver and spleen was defined as HSI. Clinical data were collected to compare the differences in the above parameters among the groups. Multiple linear regression analysis was used to analyze the correlation between HSI and clinical data and the degree of fatty degeneration. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of HSI for different degrees of hepatic steatosis. Results The differences in age, AST, ALB, TC, LDL, and TG between the mild, moderate, severe groups, and the normal group were statistically significant (all P < 0.05). The HSI values in the normal, mild, moderate, and severe groups were 1.04±0.09, 1.11±0.14, 1.22±0.13, and 1.33±0.17, respectively, with statistically significant differences among the groups (P < 0.05). The correlation analysis showed that HSI was linearly positively correlated with the degree of fatty degeneration (β=0.115, t=22.824, P＜0.001). ROC curve analysis showed that the area under the curve（AUC） for HSI in diagnosing the presence or absence of fatty liver, moderate-to-severe fatty liver, and severe fatty liver were 0.84（95% CI 0.76-0.91）, 0.86（95% CI 0.81-0.91）, and 0.80（95% CI 0.72-0.88）, respectively;The optimal cutoff points for diagnosing fatty liver, moderate-to-severe fatty liver, and severe fatty liver using HSI were 1..13（Sen：60.2%, Spe：92.3%）, 1.16（Sen：82.0%, Spe：92.4%）, and 1.24（Sen：78.3%, Spe：86.6%）, respectively. Conclusion HSI of high-frequency ultrasound has important clinical value in the grading diagnosis of NAFLD.