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肝/脾CT值、受控衰减参数(CAP)和磁共振质子密度脂肪分数(MRI-PDFF)在慢性乙型肝炎脂肪变性患者中的应用价值

鲁景楠 李岩松 温雅 王雄慧 屈兆宇 李建龙 张炜

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Citation:

肝/脾CT值、受控衰减参数(CAP)和磁共振质子密度脂肪分数(MRI-PDFF)在慢性乙型肝炎脂肪变性患者中的应用价值

DOI: 10.12449/JCH240109
基金项目: 

延安市科学技术研究发展计划项目 (2018KS-11)

利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:鲁景楠、张炜对研究的思路或设计有关键贡献;李岩松、温雅、王雄慧、屈兆宇参与了研究数据的获取分析解释过程;鲁景楠、张炜、李建龙参与起草及修改文章关键内容。
详细信息
    通信作者:

    张炜, 304180598@qq.com (ORCID: 0009-0009-2951-1115)

Application value of liver/spleen CT value, controlled attenuation parameter, and magnetic resonance imaging-proton density fat fraction in chronic hepatitis B patients with hepatic steatosis

Research funding: 

Science and Technology Research and Development Project of Yan’an (2018KS-11)

More Information
    Corresponding author: ZHANG Wei, 304180598@qq.com (ORCID: 0009-0009-2951-1115)
  • 摘要:   目的  探讨肝/脾CT值(CTL/S)、受控衰减参数(CAP)和磁共振质子密度脂肪分数(MRI-PDFF)在慢性乙型肝炎(CHB)肝脂肪变性患者中的应用价值。  方法  回顾性收集2018年10月—2022年12月在延安大学附属医院行肝脏CT、CAP和MRI-PDFF检查的213例CHB患者的临床资料。根据MRI-PDFF结果,将213例患者分为单纯CHB组(MRI-PDFF<5%,n=111)和CHB合并脂肪变性组(MRI-PDFF≥5%,n=102);其中轻度脂肪变性69例,中度至重度脂肪变性33例。符合正态分布的计量资料组间比较采用成组t检验;不符合正态分布的计量资料组间比较采用Mann-Whitney U检验。绘制Bland-Altman图,评价两位医师测量MRI-PDFF的一致性。采用Spearman相关系数分析CTL/S和MRI-PDFF、CAP和MRI-PDFF的相关性。通过分析受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC),评估CTL/S和CAP对不同程度脂肪变性的诊断价值,并使用DeLong检验比较两种影像诊断方法的AUC。  结果  MRI-PDFF在CHB患者中具有较高的可重复性及稳定性,CTL/S和MRI-PDFF之间呈显著负相关(r=-0.800,P<0.001),CAP与MRI-PDFF之间呈显著正相关(r=0.692,P<0.001)。CTL/S和CAP诊断CHB肝脂肪变性均有较高的准确度(AUC分别为0.951、0.902),且CTL/S优于CAP(P<0.05)。在检测轻度和中重度脂肪变性时,CTL/S的AUC分别为0.921和0.895,CAP的AUC分别为0.859和0.825。  结论  MRI-PDFF技术在CHB患者中具有较高的可重复性及稳定性,CTL/S和CAP对不同程度的CHB肝脂肪变性均具有较高的诊断价值。

     

  • 图  1  CTL/S测量示例图

    注: a,47岁男性,CHB合并轻度脂肪变性,CTL/S为0.85;b,44岁男性,CHB合并重度脂肪变性,CTL/S为0.43。

    Figure  1.  Sample figure of CTL/S measurements

    图  2  MRI-PDFF测量示例图

    注: a,57岁女性,CHB合并轻度脂肪变性,MRI-PDFF为6.82%;b,46岁男性,CHB合并重度脂肪变性,MRI-PDFF为17.04%。

    Figure  2.  Sample figure of MRI-PDFF measurements

    图  3  测量者间的一致性分析(Bland-Altman图)

    Figure  3.  Interobserver agreement analysis (Bland-Altman plot)

    图  4  MRI-PDFF与CTL/S、CAP的相关性分析

    Figure  4.  Correlation analysis of MRI-PDFF with CTL/S and CAP

    图  5  CTL/S和CAP检测不同程度脂肪变性的ROC曲线

    注: a,有无脂肪变性;b,轻度脂肪变性;c,中重度脂肪变性。

    Figure  5.  ROC curves of CTL/S and CAP to detect different degrees of steatosis

    表  1  单纯CHB组和CHB合并脂肪变性组的临床特征、影像学特征比较

    Table  1.   Comparison of clinical and imaging features between simple CHB group and CHB with steatosis group

    项目 单纯CHB组(n=111) CHB合并脂肪变性组(n=102) 统计值 P
    性别[例(%)] χ2=6.191 0.013
    66(59) 77(75)
    45(41) 25(25)
    年龄(岁) 50.00±11.17 47.00±9.79 t=0.146 0.084
    BMI(kg/m2 23.67(21.86~25.26) 26.38(23.88~28.40) Z=-5.887 P<0.001
    CAP(dB/m) 216.00±42.21 291.50±42.91 t=-14.236 P<0.001
    CTL/S 1.27(1.20~1.34) 0.97(0.83~1.04) Z=-11.368 P<0.001
    MRI-PDFF 2.45%(2.19%~2.80%) 7.55%(6.12%~11.85%) Z=-12.598 P<0.001
    下载: 导出CSV

    表  2  CTL/S和CAP对慢性乙型肝炎不同程度脂肪变性的诊断效能

    Table  2.   Diagnostic efficacy of CTL/S and CAP for different degrees of steatosis in chronic hepatitis B

    项目 无脂肪变性 vs 脂肪变性 无脂肪变性 vs 轻度脂肪变性 轻度脂肪变性 vs 中重度脂肪变性
    CTL/S
    最佳截断值 1.09 1.17 0.97
    AUC 0.951 0.921 0.895
    灵敏度(%) 86.3 91.2 93.9
    特异度(%) 93.7 83.9 71.0
    阳性预测值(%) 92.6 77.5 60.8
    阴性预测值(%) 88.1 94.0 96.1
    CAP
    最佳截断值 251.5 251.5 285.5
    AUC 0.9021) 0.859 0.825
    灵敏度(%) 89.2 83.8 90.9
    特异度(%) 77.5 76.8 63.8
    阳性预测值(%) 78.4 68.7 54.5
    阴性预测值(%) 88.7 88.7 93.6
    注:与CTL/S比较,1)P<0.05。
    下载: 导出CSV
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  • 收稿日期:  2023-04-20
  • 录用日期:  2023-05-06
  • 出版日期:  2024-01-23
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