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

熊玲; 王硕华; 向谦; 杜玲玲; 陈霞

doi:10.12122/j.issn.1674-4500.2021.05.17

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

doi: 10.12122/j.issn.1674-4500.2021.05.17

熊玲^1,,
王硕华²,
向谦¹,
杜玲玲²,
陈霞^1, ,

1.
成都市第六人民医院消化内科，四川成都 610051
2.
成都市第六人民医院超声影像科，四川成都 610051

基金项目:

中国肝炎防治基金会 TQGB20180125

详细信息

作者简介:
熊玲，硕士，主治医师，E-mail: ncxiongling@163.com

通讯作者:
陈霞，主任医师，E-mail: 315226579@qq.com

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出版历程
- 收稿日期: 2021-06-28
- 刊出日期: 2021-09-20

Application value of liver transient elastography and ultrasound diagnostic parameters in the diagnosis of fatty liver and the evaluation of disease severity

1.
Department of Gastroenterology, The Sixth People's Hospital of Chengdu, Chengdu 610051, China
2.
Department of Ultrasonic Imaging, The Sixth People's Hospital of Chengdu, Chengdu 610051, China

摘要

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。
- 瞬时弹性成像 /
- 超声诊断 /
- 脂肪肝 /
- 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.
- 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.

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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±0.92^abc	2.17±0.15^abc	1472.57±11.06^abc	259.79±9.14^abc
中度组(n=44)	27.14±1.09^ab	1.96±0.21^ab	1520.52±13.13	250.50±10.10^ab
轻度组(n=54)	23.11±1.20^a	1.47±0.24^a	1521.51±12.04	241.42±11.15^a
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
肝脏瞬时弹性成像诊断	脂肪肝	非脂肪肝	总计	Kappap系数	P
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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