剪切波定量技术联合生化指标评价酒精性脂肪肝的临床研究(1)
【摘要】 目的 探究剪切波定量(Elast PQ)技术联合生化指标对酒精性脂肪肝(AFL)的临床诊断效果及相关性。方法 选取30例AFL患者设为研究组， 并选取同时期的30例健康人员设为对照组。均使用Elast PQ技术检查肝脏硬度， 并应用全自动生化分析仪采集部分生化指标， 分析各检测指标与Elast PQ值的相关性， 通过ROC曲线确定AFL的诊断界值。结果 研究组Elast PQ值低于对照组， 差异具有统计学意义(P<0.05)。研究组谷氨酰转肽酶(GGT)水平高于对照组， 天门冬氨酸转移酶(AST)/丙氨酸转移酶(ALT)低于对照组， 差异具有统计学意义(P<0.05)。在研究组中Elast PQ可指示不同硬度的脂肪肝病变情况。研究组GGT、AST/ALT与肝脏Elast PQ值呈正相关性(r=0.65、0.57， P<0.05)；对照组GGt、AST/ALT与elast PQ值无明显相关性(P>0.05)。研究组ROC曲线下最大面积为(0.85±0.03)， 面积标准误差为0.02， 置信区间为95%(0.82、0.94)。当Elast PQ值=3.67 kPa有最高特异性和敏感度， 分别为67%、85%。
结论 Elast PQ技术联合代谢指标能够准确判定AFL， 且结果敏感度高、准确度高， 应于临床重点推广。
【关键词】 剪切波定量技术；生化指标；酒精性脂肪肝
DOI：10.14163/j.cnki.11-5547/r.2017.08.013
【Abstract】 Objective To investigate clinical diagnostic effect and correlation by shear wave quantification (Elast PQ) technique combined with biochemical index for alcoholic fatty liver (AFL). Methods There were 30 AFL patients as research group and 30 healthy people at the same period as control group. They all received Elast PQ technique for liver stiffness measurement， and fully automatic biochemical analyzer for biochemical index collection. Analysis was made on correlation between detection indexes and Elast PQ. ROC curve was applied to determine diagnostic cut-off point in AFL. Results The research group had lower Elast PQ value than the control group， and the difference had statistical significance (P<0.05). The research group had higher glutamyl transpeptidase (GGT) level and lower aspartate aminotransferase (AST)/alanine aminotransferase (ALT) level than the control group， and their difference had statistical significance (P<0.05). Elast PQ showed fatty liver lesion with different stiffness in this research. The research group showed positive correlation between GGT， AST/ALT and liver Elast PQ value (r=0.65， 0.57， P<0.05). There was no obvious correlation between GGT， AST/ALT and Elast PQ value in the control group (P>0.05). The research group had the largest area under ROC curve as (0.85±0.03)， area standard error as 0.02， and confidence interval as 95% (0.82， 0.94). The highest specificity and sensibility were shown at Elast PQ value = 3.67 kPa as 67% and 85%. Conclusion Combination of Elast PQ technique and metabolic index can accurately diagnose AFL， along with high sensibility and accuracy in its outcome. This method requires emphasized clinical promotion.
【Key words】 Shear wave quantification technique； Biochemical index； Alcoholic fatty liver
AFL是多是由于長期、大量、持续饮酒导致干细胞被过量乙醇侵染， 并生成对肝细胞具有毒性的乙醛， 进而致肝细胞纤维化、坏死， 甚至发展为肝硬化、肝癌[1]， 严重者会危害其生命安全。AFL属于纤维化肺疾病(Fibrotic Lung Disease， FLD)中较为常见的一种， 非侵入性超声诊断技术是当前主流的FLD诊断手段， Elast PQ就是其中一种。Elast PQ是利用超声仪发出一个高强度的纵向脉冲波至测定区， 使测定区产生相应的横向剪切波， 超声仪对回馈的横向剪切波进行捕捉， 对其波速进行计算， 进而得到能够指向测定区硬度的相关指标和参数[2]。但鉴于超声诊断往往受机器、患者条件、操作者经验等多因素的影响， 不能很好地区分酒精性及非酒精性脂肪肝[3， 4]， GGT对AFL具有较高的敏感度[5]， 所以使用Elast PQ技术联合生化检测能够提高AFL诊断的准确性。, http://www.100md.com(李桂萍)
结论 Elast PQ技术联合代谢指标能够准确判定AFL， 且结果敏感度高、准确度高， 应于临床重点推广。
【关键词】 剪切波定量技术；生化指标；酒精性脂肪肝
DOI：10.14163/j.cnki.11-5547/r.2017.08.013
【Abstract】 Objective To investigate clinical diagnostic effect and correlation by shear wave quantification (Elast PQ) technique combined with biochemical index for alcoholic fatty liver (AFL). Methods There were 30 AFL patients as research group and 30 healthy people at the same period as control group. They all received Elast PQ technique for liver stiffness measurement， and fully automatic biochemical analyzer for biochemical index collection. Analysis was made on correlation between detection indexes and Elast PQ. ROC curve was applied to determine diagnostic cut-off point in AFL. Results The research group had lower Elast PQ value than the control group， and the difference had statistical significance (P<0.05). The research group had higher glutamyl transpeptidase (GGT) level and lower aspartate aminotransferase (AST)/alanine aminotransferase (ALT) level than the control group， and their difference had statistical significance (P<0.05). Elast PQ showed fatty liver lesion with different stiffness in this research. The research group showed positive correlation between GGT， AST/ALT and liver Elast PQ value (r=0.65， 0.57， P<0.05). There was no obvious correlation between GGT， AST/ALT and Elast PQ value in the control group (P>0.05). The research group had the largest area under ROC curve as (0.85±0.03)， area standard error as 0.02， and confidence interval as 95% (0.82， 0.94). The highest specificity and sensibility were shown at Elast PQ value = 3.67 kPa as 67% and 85%. Conclusion Combination of Elast PQ technique and metabolic index can accurately diagnose AFL， along with high sensibility and accuracy in its outcome. This method requires emphasized clinical promotion.
【Key words】 Shear wave quantification technique； Biochemical index； Alcoholic fatty liver
AFL是多是由于長期、大量、持续饮酒导致干细胞被过量乙醇侵染， 并生成对肝细胞具有毒性的乙醛， 进而致肝细胞纤维化、坏死， 甚至发展为肝硬化、肝癌[1]， 严重者会危害其生命安全。AFL属于纤维化肺疾病(Fibrotic Lung Disease， FLD)中较为常见的一种， 非侵入性超声诊断技术是当前主流的FLD诊断手段， Elast PQ就是其中一种。Elast PQ是利用超声仪发出一个高强度的纵向脉冲波至测定区， 使测定区产生相应的横向剪切波， 超声仪对回馈的横向剪切波进行捕捉， 对其波速进行计算， 进而得到能够指向测定区硬度的相关指标和参数[2]。但鉴于超声诊断往往受机器、患者条件、操作者经验等多因素的影响， 不能很好地区分酒精性及非酒精性脂肪肝[3， 4]， GGT对AFL具有较高的敏感度[5]， 所以使用Elast PQ技术联合生化检测能够提高AFL诊断的准确性。, http://www.100md.com(李桂萍)