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基于瞬时弹性成像技术检测参数的非酒精性脂肪性肝病进展评估模型的建立

姚明解 文夏杰 王雷婕 何琼 罗建文 范建高 谢青 陈成伟 傅青春 施军平 杨永峰 徐芸 陆伦根 鲁凤民

姚明解, 文夏杰, 王雷婕, 等. 基于瞬时弹性成像技术检测参数的非酒精性脂肪性肝病进展评估模型的建立[J]. 临床肝胆病杂志, 2021, 37(7): 1614-1618. DOI: 10.3969/j.issn.1001-5256.2021.07.027
引用本文: 姚明解, 文夏杰, 王雷婕, 等. 基于瞬时弹性成像技术检测参数的非酒精性脂肪性肝病进展评估模型的建立[J]. 临床肝胆病杂志, 2021, 37(7): 1614-1618. DOI: 10.3969/j.issn.1001-5256.2021.07.027
YAO MJ, WEN XJ, WANG LJ, et al. Establishment of a model for evaluating the severity of nonalcoholic fatty liver disease based on transient elastography parameters[J]. J Clin Hepatol, 2021, 37(7): 1614-1618. DOI: 10.3969/j.issn.1001-5256.2021.07.027
Citation: YAO MJ, WEN XJ, WANG LJ, et al. Establishment of a model for evaluating the severity of nonalcoholic fatty liver disease based on transient elastography parameters[J]. J Clin Hepatol, 2021, 37(7): 1614-1618. DOI: 10.3969/j.issn.1001-5256.2021.07.027

基于瞬时弹性成像技术检测参数的非酒精性脂肪性肝病进展评估模型的建立

DOI: 10.3969/j.issn.1001-5256.2021.07.027
基金项目: 

国家自然科学基金青年项目 81902115

国家重点研发计划项目 SQ2020YFF0426358

国家十三五“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项基金 2017ZX10302201

国家十三五“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项基金 2017ZX10202203

中国博士后科学基金 2017M620802

北京市科学技术委员会资助项目 Z161100000116047

详细信息
    通讯作者:

    陆伦根,lungenlu1965@163.com

    鲁凤民,lu.fengmin@bjmu.edu.cn

  • 中图分类号: R575.5

Establishment of a model for evaluating the severity of nonalcoholic fatty liver disease based on transient elastography parameters

Funds: 

National Natural Science Foundation of China Grant 81902115

National Key Research and Development Program of China SQ2020YFF0426358

National Science and Technology Major Project for Infectious Diseases 2017ZX10302201

National Science and Technology Major Project for Infectious Diseases 2017ZX10202203

China Postdoctoral Science Foundation 2017M620802

Beijing Municipal Science & Technology Commission Z161100000116047

  • 摘要:   目的  通过对基于瞬时弹性成像技术检测参数联合分析,建立对非酒精性脂肪性肝病(NAFLD)病情严重程度的评估模型。  方法  回顾性收集2014年7月—2017年7月在我国7家医院就诊的具有肝穿刺病理学诊断的184例NAFLD患者的临床信息及肝弹性相关参数。将iLivTouch肝弹性检测参数得到的和弹性、超声信号的幅度、频率、散射及衰减程度相关的多参数分别命名为P1~P18。通过Spearman相关性检验、线性回归分析分别建立用于NAFLD患者脂肪变程度、炎症活动度、肝纤维化程度判断模型,使用受试者工作特征曲线(ROC曲线)对模型诊断价值进行评价。  结果  基于瞬时弹性成像技术的相关超声参数与NAFLD患者肝脂肪变、炎症活动度与肝纤维化程度有良好的相关性。多因素分析结果显示,P1、P12是肝脂肪变程度的独立相关指标(P值均<0.05),P1、P3、P6、P11是肝脏炎症活动度的独立相关指标(P值均<0.05),P2、P3与肝纤维化程度显著相关(P值均<0.05)。通过线性回归建立的肝脂肪变程度判断模型:Y=0.013×P1+0.055×P12-0.318 5,对轻度及中重度脂肪变诊断的ROC曲线下面积(AUC)分别为0.895(95%CI:0.842~0.936)、0.939(95%CI:0.894~0.969),敏感度分别为82.35%、86.26%,特异度分别为89.23%、93.27%,P值均<0.001;肝脏炎症活动度诊断模型:Y=0.008×P1+0.030×P3+0.029×P6-1.875×10-4×P11+0.416,对早期炎症及显著炎症活动诊断的AUC分别为0.828(95%CI:0.793~0.865)、0.874(95%CI:0.817~0.918),敏感度分别为70.6%、73.96%,特异度分别为85.7%、93.33%,P值均<0.001;肝纤维化程度诊断模型:Y=-0.003×P1+0.601×(lnP2)+0.285×(lnP3)+0.036×P15+0.078,对显著纤维化、严重纤维化及早期肝硬化诊断的AUC分别为0.805(95%CI:0.740~0.869)、0.767(95%CI:0.699~0.827)、0.803(95%CI:0.701~0.906),敏感度分别为72.27%、77.63%和90.00%,特异度分别为79.69%、66.42%和66.47%,P值均<0.001。  结论  瞬时弹性成像技术检测不同参数能够分别有效反映NAFLD患者脂肪变程度、炎症活动度及纤维化程度,通过联合模型能够提高对NAFLD患者疾病严重程度判断的准确性。

     

  • 表  1  研究对象的一般情况

    指标 数值
    男/女(例) 114/70
    年龄(岁) 40 (26~51)
    ALT(U/L) 53(29~97)
    AST(U/L) 41(26~60)
    GGT(U/L) 54(31~98)
    脂肪变评分(0/1/2/3,例) 65/39/48/32
    气球样变评分(0/1/2,例) 22/47/115
    小叶炎症评分(0/1/2,例) 16/70/98
    纤维化评分(0/1/2/3/4,例)1) 25/38/43/65/10
    注:1)纤维化评分有3例研究对象缺失,在后期有关纤维化模型构建中未纳入研究。
    下载: 导出CSV

    表  2  超声参数与NAFLD人群脂肪变程度、炎症活动度及肝纤维化程度相关性分析

    变量 脂肪变程度 炎症活动度 肝纤维化程度
    r P r P r P
    P1 0.748 <0.001 0.154 0.037 -0.068 0.358
    P2 -0.014 0.849 0.161 0.029 0.510 <0.001
    P3 0.003 0.969 0.241 0.001 0.476 <0.001
    P4 0.578 <0.001 0.078 0.293 -0.008 0.918
    P5 0.334 <0.001 0.186 0.011 0.100 0.177
    P6 0.469 <0.001 0.271 <0.001 0.123 0.097
    P7 0.653 <0.001 0.065 0.382 -0.047 0.527
    P8=P10 0.680 <0.001 0.111 0.133 0.101 0.174
    P9 0.649 <0.001 0.091 0.221 -0.032 0.665
    P11 0.714 <0.001 0.1331 0.071 0.075 0.312
    P12 0.677 <0.001 0.116 0.118 0.107 0.105
    P14 0.513 <0.001 0.094 0.203 -0.012 0.871
    P15=P17 0.521 <0.001 0.117 0.115 0.113 0.128
    P16 0.669 <0.001 0.103 0.162 -0.029 0.700
    P18 0.694 <0.001 0.085 0.250 -0.012 0.868
    下载: 导出CSV

    表  3  线性回归判定对于NAFLD人群脂肪变程度具有预测价值的参数

    参数 B SE t P
    常量 -3.185 0.293 -11.455 <0.001
    P1 0.013 0.001 8.670 <0.001
    P12 0.055 0.013 0.277 <0.001
    下载: 导出CSV

    表  4  线性回归判定对于NAFLD人群肝脏炎症活动度具有预测价值的参数

    参数 B SE t P
    常量 0.416 0.590 0.705 0.482
    P1 0.008 0.003 3.036 0.003
    P3 0.030 0.009 3.442 0.001
    P6 0.029 0.015 1.930 0.055
    P11 -1.875×10-4 <0.001 -2.455 0.015
    下载: 导出CSV

    表  5  线性回归判定对于NAFLD人群纤维化程度具有预测价值的参数

    参数 B SE t P
    常量 0.078 0.477 0.164 0.870
    P1 -0.003 0.002 -1.962 0.051
    lnP2 0.601 0.237 2.534 0.012
    lnP3 0.285 0.189 1.506 0.134
    P15 0.036 0.015 2.438 0.016
    下载: 导出CSV
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  • 收稿日期:  2020-11-20
  • 修回日期:  2021-01-11
  • 刊出日期:  2021-07-20
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