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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (01) : 57 -62. doi: 10.3877/cma.j.issn.1672-6448.2023.01.010

腹部超声影像学

超声衰减成像技术评价肝脂肪变性的相关因素分析
万欣1, 贺秋霞1, 李明明1, 王守志1, 陈曦1, 杨秀华1,()   
  1. 1. 150000 哈尔滨医科大学附属第一医院腹部超声科
  • 收稿日期:2021-04-04 出版日期:2023-01-01
  • 通信作者: 杨秀华
  • 基金资助:
    基于光热和光致相变技术的靶向超声微泡对肝细胞癌的治疗作用及机制研究(81871362)

Correlative factors analysis in evaluating hepatic steatosis by ultrasound attenuation imaging technology

Xin Wan1, Qiuxia He1, Mingming Li1, Shouzhi Wang1, Xi Chen1, Xiuhua Yang1,()   

  1. 1. Department of Abdominal Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin 15000, China
  • Received:2021-04-04 Published:2023-01-01
  • Corresponding author: Xiuhua Yang
引用本文:

万欣, 贺秋霞, 李明明, 王守志, 陈曦, 杨秀华. 超声衰减成像技术评价肝脂肪变性的相关因素分析[J/OL]. 中华医学超声杂志(电子版), 2023, 20(01): 57-62.

Xin Wan, Qiuxia He, Mingming Li, Shouzhi Wang, Xi Chen, Xiuhua Yang. Correlative factors analysis in evaluating hepatic steatosis by ultrasound attenuation imaging technology[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(01): 57-62.

目的

探讨影响超声衰减系数(AC)变化的相关因素,并评估衰减成像(ATI)技术对非酒精性脂肪性肝病(NAFLD)定量诊断的临床实用性及测量的可重复性。

方法

选取2019年9月至2020年12月在哈尔滨医科大学附属第一医院使用超声的ATI技术进行肝检测的114例受试者(NAFLD组56例,健康对照组58例),分别获得二维超声和AC,同时收集患者相应的临床资料、血生化检测指标等,通过多因素线性回归分析确定AC的独立影响因素。使用常规二维超声检查对所有研究对象的肝脂肪变性程度进行四分制评分(S0~S3组),采用方差分析检验各组间AC的差异性,使用Spearman相关分析方法评估AC与肝脂肪变性程度的相关性,并计算组内相关系数(ICC),评估2名操作者间(AC-1组和AC-2组)ATI测量的可重复性。

结果

多因素线性回归分析显示体质量指数(BMI)、肝脂肪变性程度是AC的独立影响因素(β=0.007,95%CI:0.001~0.013,P=0.017;β=0.083,95%CI:0.070~0.095,P<0.001)。NAFLD组AC显著高于健康对照组[AC-1组:(0.716±0.098)dB/(cm·MHz)vs(0.539±0.058)dB/(cm·MHz);AC-2组:(0.699±0.102)dB/(cm·MHz)vs(0.542±0.053)dB/(cm·MHz)],且随着肝脂肪变性程度的加重,AC逐渐升高[S0组(58例)AC为(0.539±0.058)dB/(cm·MHz),S1组(23例)AC为(0.640±0.063)dB/(cm·MHz),S2组(20例)AC为(0.718±0.050)dB/(cm·MHz),S3组(13例)AC为(0.845±0.059)dB/(cm·MHz);F=122.27,P<0.001]。AC与肝脂肪变性程度存在较强的相关性(r=0.840;P<0.001)。不同肝脂肪变性程度AC的组内相关系数(ICC)分别为0.816(95%CI:0.708~0.881)、0.886(95%CI:0.301~0.967)、0.876(95%CI:0.479~0.960)、0.939(95%CI:0.819~0.981),P均<0.001。

结论

AC与BMI、肝脂肪变性程度显著相关,且ATI技术的操作者间可重复性极好,结果较为稳定,有助于早期发现脂肪肝并对脂肪肝严重程度进行评估。

Objective

Identify factors associated with the change of ultrasound attenuation coefficient (AC) and evaluate the clinical utility and inter-observer reproducibility of attenuation imaging (ATI) technique for the quantitative diagnosis of nonalcoholic fatty liver disease (NAFLD).

Methods

A total of 114 subjects (56 NAFLD patients and 58 healthy controls) who underwent liver testing using ATI technique with ultrasound at the First Affiliated Hospital of Harbin Medical University from September 2019 to December 2020 were selected to obtain two-dimensional ultrasound and AC, respectively. Clinical data and blood biochemical test indicators of the patients were collected, and independent influencing factors of AC were identified by multivariate linear regression analysis. A 4-point scale (S0 to S3 groups) was used for assessing the degree of hepatic steatosis in all study subjects based on conventional 2-dimensional ultrasonography. ANOVA was used to test the differences in AC between groups, Spearman's correlation was used to assess the correlation between AC and the degree of hepatic steatosis, and intraclass correlation coefficient (ICC) was calculated to assess the reproducibility of ATI measurements between two operators (AC-1 and AC-2 groups).

Results

Multivariate linear regression analysis revealed that body mass index and degree of hepatic steatosis were independent influencing factors of AC values (β=0.007, 95%CI: 0.001~0.013, P=0.017; β=0.083, 95%CI: 0.070~0.095, P<0.001). The NAFLD group had significantly higher AC than the healthy control group [AC-1: (0.716±0.098) dB/(cm·MHz) vs (0.539±0.058) dB/(cm·MHz); AC-2: (0.699±0.102) dB/(cm·MHz) vs (0.542±0.053) dB/(cm·MHz)]; AC increased gradually with the increase in the degree of hepatic steatosis [S0 (n=58): (0.539±0.058) dB/(cm·MHz); S1 (n=23): (0.640±0.063) dB/(cm·MHz); S2 (n=20): (0.718±0.050) dB/(cm·MHz); S3 (n=13): (0.845±0.059) dB/(cm·MHz); F=122.27, P<0.001]. There was a strong correlation between AC and the degree of hepatic steatosis (r=0.840, P<0.001). For the inter-observer reproducibility of ATI, the ICC of the AC values for different degrees of hepatic steatosis was 0.816 (95%CI: 0.708-0.881), 0.886 (95%CI: 0.301-0.967), 0.876 (95%CI: 0.479-0.960), and 0.939 (95%CI: 0.819-0.981), respectively (P<0.001).

Conclusion

AC values are significantly correlated with body mass index and degree of hepatic steatosis. The inter-operator reproducibility of the ATI technique is excellent with stable results, thus AC facilitates early detection of fatty liver and assessment of fatty liver severity.

图1 衰减成像技术声衰减成像图。图a为正常肝,衰减系数为0.41 dB/(cm·MHz);图b为脂肪肝,衰减系数为0.81 dB/(cm·MHz)
表1 2组受试者一般临床资料比较
图2 不同程度肝脂肪变性组衰减系数比较注:S0为无脂肪变性;S1为轻度脂肪变性;S2为中度脂肪变性;S3为重度脂肪变性
表2 非酒精性脂肪性肝病患者超声衰减系数的相关影响因素分析
表3 所有受试者各组操作者间衰减系数的组内相关系数
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