超声实时剪切波弹性成像、血清透明质酸对非酒精性脂肪性肝病的诊断价值

Diagnostic value of real-time shear wave ultrasound elastography combined with serum hyaluronic acid for non-alcoholic fatty liver disease

摘要:

目的 探究超声实时剪切波弹性成像、血清纤维化标志物透明质酸对非酒精性脂肪性肝病的诊断价值。方法 选取2020年4月—2023年4月在皖南医学院附属宣城医院（宣城市人民医院）就诊的非酒精性脂肪性肝病患者112例作为肝病组，另取同期该院肝功能正常的健康体检者112例作为对照组。收集所有受试者的病历/体检资料，行超声实时剪切波弹性成像检查及血清透明质酸检测。非酒精性脂肪性肝病均以肝组织活检作为诊断金标准。比较两组杨氏模量值及血清透明质酸水平；评估超声实时剪切波弹性成像、血清透明质酸对非酒精性脂肪性肝病的诊断效能。结果 肝病组透明质酸、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平均高于对照组（P <0.05），杨氏模量值高于对照组（P <0.05）。多因素逐步Logistic回归分析结果显示：杨氏模量值［O^R=4.627（95% CI：1.627，13.159）］是非酒精性脂肪性肝病的保护因素；透明质酸［O^R=4.116（95% CI：1.924，8.807）］、ALT ［O^R=3.691（95% CI：1.725，7.898）］和AST ［O^R=3.846（95% CI：1.798，8.229）］是非酒精性脂肪性肝病的危险因素（P <0.05）。受试者工作特征曲线分析结果显示，杨氏模量值、透明质酸及其联合诊断非酒精性脂肪性肝病的敏感性分别为68.9%（95% CI：0.591，0.752）、76.2%（95% CI：0.695，0.843）、84.3%（95% CI：0.726，0.935），特异性分别为83.1%（95% CI：0.723，0.921）、68.4%（95% CI：0.571，0.794）、83.5%（95% CI：0.719，0.926）。结论 超声实时剪切波弹性成像联合血清透明质酸可辅助诊断非酒精性脂肪性肝病，诊断效能良好。

Abstract:

Objective To explore the diagnostic value of real-time shear wave ultrasound elastography combined with serum fibrosis marker hyaluronic acid for non-alcoholic fatty liver disease.Methods From April 2020 to April 2023, the 112 patients with non-alcoholic fatty liver disease treated in the Affiliated Xuancheng Hospital of Wannan Medical College were selected as the liver disease group. Additionally, 112 healthy individuals with normal liver function who underwent health checkup in the hospital during the same period were selected as the control group. Medical records of all participants were collected, and all of them underwent real-time shear wave ultrasound elastography and were tested for serum hyaluronic acid. The diagnosis of non-alcoholic fatty liver disease was confirmed by liver tissue biopsy as the gold standard. The Young's modulus values and the serum levels of hyaluronic acid were compared between the two groups. The diagnostic performance of real-time shear wave ultrasound elastography and serum hyaluronic acid for non-alcoholic fatty liver disease was evaluated.Results The levels of hyaluronic acid, ALT and AST in the liver disease group were higher than those in the control group (P < 0.05), and Young's modulus values in the liver disease group were higher than those in the control group (P < 0.05). Multivariable stepwise Logistic regression analysis revealed that low Young's modulus value [O^R = 4.627 (95% CI: 1.627, 13.159) ] was a protective factor for non-alcoholic fatty liver disease, and that high levels of hyaluronic acid [O^R = 4.116 (95% CI: 1.924, 8.807) ], ALT [O^R = 3.691 (95% CI: 1.725, 7.898) ] and AST [O^R = 3.846 (95% CI: 1.798, 8.229) ] were risk factors for non-alcoholic fatty liver disease (P < 0.05). The receiver operating characteristic analysis demonstrated that the sensitivities of the Young's modulus value and the serum level of hyaluronic acid alone and their combination for diagnosing non-alcoholic fatty liver disease were 68.9% (95% CI: 0.591, 0.752), 76.2% (95% CI: 0.695, 0.843) and 84.3% (95% CI: 0.726, 0.935), with the specificities being 83.1% (95% CI: 0.723, 0.921), 68.4% (95% CI: 0.571, 0.794) and 83.5% (95% CI: 0.719, 0.926).Conclusion Real-time shear wave ultrasound elastography combined with serum hyaluronic acid could assist the diagnosis of non-alcoholic fatty liver disease with good diagnostic performance.