Application value of liver transient elastography and ultrasound diagnostic parameters in the diagnosis of fatty liver and the evaluation of disease severity
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摘要:
目的 探究肝脏瞬时弹性成像和超声诊断参数在脂肪肝诊断及病情程度评估中的应用价值。 方法 选择2019年1月1日~ 2021年3月1日于我院确诊为脂肪肝的120例患者作为观察组，并选取同时期健康体检者50例作为对照组，均行肝脏彩色多普勒超声及瞬时弹性成像检查。根据肝脏常规检查(肝脏大小、肝实质回声)结果对观察组患者进行病情程度评估，将患者分为轻度组(n=54)、中度组(n=44)和重度组(n=24)，分别比较4组BMI、皮下脂肪层厚度、肝组织声速值、肝脏硬度值，采用Kappa一致性检验分析肝脏瞬时弹性成像与彩色多普勒超声诊断脂肪肝结果一致性，线性趋势卡方检验分析肝脏瞬时弹性成像与彩色多普勒超声诊断脂肪肝的相关性。 结果 对照组、轻度组、中度组、重度组患者BMI、皮下脂肪层厚度、肝脏硬度值依次增加，中度组、重度组患者肝组织声速值依次降低(P < 0.05)，对照组、轻度组、中度组患者肝组织声速值差异无统计学意义(P>0.05)；肝脏瞬时弹性成像与彩色多普勒超声诊断脂肪肝结果一致性良好(Kappa=0.67，P < 0.05)；肝脏瞬时弹性成像与彩色多普勒超声诊断脂肪肝相关性有统计学意义，且肝脏瞬时弹性成像对于轻、中度脂肪肝区分度高于彩色多普勒超声(总变异χ2=298.25，线性回归分量χ2=203.47，偏离线性回归分量χ2=91.43，P < 0.05)。 结论 肝脏瞬时弹性成像和超声诊断脂肪肝一致性良好，但肝脏瞬时弹性成像可更精细区分病情程度。 Abstract:Objective To explore the application value of liver transient elastography and ultrasound diagnostic parameters in fatty liver diagnosis and disease severity evaluation. Methods A total of 120 patients with fatty liver in our hospital between January 1, 2019 and March 1, 2021 were enrolled as observation group. Fifty healthy subjects with physical examination during the same period were treated as control group. All patients underwent liver color Doppler ultrasound and transient elastography. According to the results of liver routine examination (liver size, liver parenchymal echo), the patients in observation group were given disease severity evaluation, and then divided into mild group (n=54), moderate group (n=44) and severe group (n=24). BMI, subcutaneous fat layer thickness, liver tissue sound velocity and liver stiffness value were compared among control group, mild fatty liver group, moderate fatty liver and severe fatty liver group, respectively. Kappa consistency test was used to analyze the consistency of liver transient elastography and color Doppler ultrasound in diagnosing fatty liver. Linear trend chi-square test was applied to analyze the correlation between liver transient elastography and color Doppler ultrasound in the diagnosis of fatty liver. Results The BMI, subcutaneous fat layer thickness and liver stiffness value of control group, mild group, moderate group and severe group and the liver tissue sound velocity of moderate group and severe group were increased (P < 0.05). There was no significant difference in liver tissue sound velocity among control group, mild group and moderate group (P>0.05). Liver transient elastography and color Doppler ultrasound showed good consistency in the diagnosis of fatty liver (Kappa=0.67, P < 0.05). Chi-square test showed that the liver transient elastography and color Doppler ultrasound were significantly relevant in diagnosing fatty liver. The liver transient elastography was more discriminating than color Doppler ultrasound for mild-to-moderate fatty liver (total variation χ2= 298.25, linear regression component χ2=203.47, deviation from linear regression component χ2=91.43, P < 0.05). Conclusion Liver transient elastography and ultrasound are consistent in the diagnosis of fatty liver, but liver transient elastography can distinguish the severity of the disease more finely. -
Key words:
- transient elastography /
- ultrasound diagnosis /
- fatty liver /
- disease severity
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图 1 不同程度脂肪变患者的肝脏瞬时弹性成像影像学表现
A：无脂肪变；B：轻度脂肪变；C：中度脂肪变；D：重度脂肪变.
Figure 1. Imaging manifestations of liver transient elastography in patients with different degrees of fatty degeneration.
表 1 4组BMI、皮下脂肪层厚度、肝组织声速值、CAP比较
Table 1. Comparison of BMI, subcutaneous fat layer thickness, liver tissue sound velocity and CAP among the four groups (Mean±SD)
组別 BM(kg/m2) 皮下脂肪层厚度(cm) 声速值(m/s) CAP(db/m) 重度组(n=24) 28.47±0.92abc 2.17±0.15abc 1472.57±11.06abc 259.79±9.14abc 中度组(n=44) 27.14±1.09ab 1.96±0.21ab 1520.52±13.13 250.50±10.10ab 轻度组(n=54) 23.11±1.20a 1.47±0.24a 1521.51±12.04 241.42±11.15a 对照组(n=50) 21.62±1.15 1.29±0.20 1522.24±11.73 211.13±11.28 F 384.791 180.598 181.343 178.518 P < 0.001 < 0.001 < 0.001 < 0.001 aP < 0.05 vs对照组；bP < 0.05 vs轻度组；cP < 0.05 vs中度组. CAP: 肝脏硬度值. 
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表 2 肝脏瞬时弹性成像与彩色多普勒超声诊断脂肪肝结果一致性分析
Table 2. Consistency analysis of liver transient elastography and color Doppler ultrasound in the diagnosis of fatty liver (n)
肝脏瞬时弹性成像诊断 彩色多普勒超声诊断 总计 Kappap系数 P 脂肪肝 非脂肪肝 脂肪肝 109 12 121 0.67 < 0.05 非脂肪肝 11 38 49 总计 120 50 170
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