非酒精性脂肪肝患者彩色多普勒超声测定肝静脉频谱与CAP测值的临床相关性研究
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摘要
目的:分析研究非酒精性脂肪肝病(NAFLD)患者彩色多普勒超声检测肝静脉血流频谱、瞬间弹性成像控制衰减参数(CAP)测值及超声结果的相关性。方法:选择行腹部超声检查及CAP检查,且临床诊断为非酒精性脂肪肝患者104例为试验组。另选择门诊正常健康体检者76例为对照组。对两组人群的超声声像图、肝右静脉血流频谱、肝右静脉最大血流速度以及CAP值进行观察并分析。结果:①因筛查标准为超声描述脂肪肝,故对照组全部为正常,轻度、中度、重度均为0例。健康体检者有9例(5.0%),CAP值升高,其中轻度者6例(3.3%),差异有统计学意义(P<0.001)。健康体检者中HV1型改变为7例(3.9%),而20例HV2型均符合脂肪肝表现,差异有统计学意义(P<0.001)。CAP值在试验组中明显高于对照组,差异有统计学意义(P<0.001)。肝右静脉最大流速在试验组中低于对照组,差异有统计学意义(P<0.001)。②肝右静脉脉冲多普勒频谱与CAP值呈正相关,差异有统计学意义(P<0.001)。肝右静脉脉冲多普勒频谱与肝右静脉最大流速呈负相关,差异有统计学意义(P=0.019)。③肝右静脉脉冲多普勒频谱对正常CAP值人群敏感性,高于超声描述甚至联合方案,差异有统计学意义(P<0.001)。而在CAP值非正常人群中,HV0特异性低于超声描述以及联合方案,差异有统计学意义(P<0.001)。结论:应用彩色多普勒超声检测联合肝静脉血流频谱,对脂肪肝,尤其是在缺少CAP诊断技术时,对轻度脂肪肝的诊断提供了较为可靠的参考依据。
Objective Analysis the correlation between hepatic vein blood fiow spectrum 、Instantaneous elastic imaging controls attenuation paramaeters(CAP) and Ultrasound results in patients with Nonalcoholic Fatty liver Disease by color Doppler ultrasound.Method ①NAFLD(104 cases)and healthy physical examination controls(76 cases)were examined by using color Doppler ultrasound.Observation and analysis were carried out on the results of Ultrasound,Right hepatic vein blood flow spectrum,Maximum blood flow velocity of right hepatic veinas,well as CAP.Results ①Because of the use of ultrasound descriptions as screening criteria,so all of the control group was normal.The number of mild,moderate and severe patients was zero.9(5.0%) of the healthy people had increased CAP results,of which 6(3.3%) were mild(P<0.001).There were 7 patients(3.9%) with HV1 change,and 20 patients with HV2 change which were in accordance with fatty liver manifestations(P<0.001).The CAP value of the experimental group was significantly higher than that of the control group(P<0.001).Maximum blood flow velocity of right hepatic veinas of the experimental group was lower than that of the control group(P<0.001).②Right hepatic vein blood flow spectrum and Maximum blood flow velocity of right hepatic veinas were negatively correlated(P=0.019).③The sensitivitity of Right hepatic vein blood flow spectrum to normal CAP group was higher than that of Ultrasound results or even combined regimen(P<0.001).The specificity of Right hepatic vein blood flow spectrum HV0 to normal CAP group was lower than that of Ultrasound results or even combined regimen(P<0.001).Conclusion the application of color ultrasound to the detection of hepatic venous blood flow spectrum provides a reliable reference for the diagnosis of mild fatty liver,especially in the absence of CAP diagnostic technique.
Objective Analysis the correlation between hepatic vein blood fiow spectrum 、Instantaneous elastic imaging controls attenuation paramaeters(CAP) and Ultrasound results in patients with Nonalcoholic Fatty liver Disease by color Doppler ultrasound.Method ①NAFLD(104 cases)and healthy physical examination controls(76 cases)were examined by using color Doppler ultrasound.Observation and analysis were carried out on the results of Ultrasound,Right hepatic vein blood flow spectrum,Maximum blood flow velocity of right hepatic veinas,well as CAP.Results ①Because of the use of ultrasound descriptions as screening criteria,so all of the control group was normal.The number of mild,moderate and severe patients was zero.9(5.0%) of the healthy people had increased CAP results,of which 6(3.3%) were mild(P<0.001).There were 7 patients(3.9%) with HV1 change,and 20 patients with HV2 change which were in accordance with fatty liver manifestations(P<0.001).The CAP value of the experimental group was significantly higher than that of the control group(P<0.001).Maximum blood flow velocity of right hepatic veinas of the experimental group was lower than that of the control group(P<0.001).②Right hepatic vein blood flow spectrum and Maximum blood flow velocity of right hepatic veinas were negatively correlated(P=0.019).③The sensitivitity of Right hepatic vein blood flow spectrum to normal CAP group was higher than that of Ultrasound results or even combined regimen(P<0.001).The specificity of Right hepatic vein blood flow spectrum HV0 to normal CAP group was lower than that of Ultrasound results or even combined regimen(P<0.001).Conclusion the application of color ultrasound to the detection of hepatic venous blood flow spectrum provides a reliable reference for the diagnosis of mild fatty liver,especially in the absence of CAP diagnostic technique.
引文
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[17] SASSO M,BEAUGRAND M,de LEDINGHEN V,et al.Controlled attenuation parameter(CAP):a novel VCTMTM guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis:preliminary study and validation in a cohort of patients with chronic liver disease from various causes[J].Ultrasound Med Biol,2010,36(11):1825.
[18] Yilmaz Y,Ergelen R,Akin H,et al.Noninvasive detection of hepatic steatosis in patients without ultrasonographic evidence of fatty liver using the controlled attenuation parameter evaluated with transient elastography[J].European Journal of Gastroenterology & Hepatology,2013,25(11):1330.
[19] Chon Y E,Jung K S,Kim S U,et al.Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases:a prospective study of a native Korean population[J].Liver International,2013,34(1):102.
[20] 张旻.肝静脉多普勒频谱与乙醇性肝病的相关性研究[J].吉林医学,2014,35(13):2832.
[21] 管湘平,高燕华.不同程度脂肪肝的肝静脉血流频谱变化[J].中国临床保健杂志,2009,12(3):228.
[22] 金玲,丁虹,富凤萍.海勤人员非酒精性脂肪肝门静脉血流动力学改变的观察[J].人民军医,2011,54(4):273.
[23] 李保启,许红强,王金萍,等.彩色多普勒超声检测非酒精性脂肪肝患者血流动力学变化的应用价值研究,Chinese General Practice,2013,16(1):130.
[2] 卢加发,范建高.受控衰减参数评估脂肪性肝病的研究进展[J].临床肝胆病杂志,2015,31(5):806.
[3] 中华医学肝脏病学分会脂肪肝和酒精性肝病学组,非酒精性脂肪肝病诊疗指南(2010年修订版)[J].中华肝脏病杂志,2010,18(3):163.
[4] Uzun H,Yazici B,Erdogmus B,et al.Doppler wave from of the hepatic veins in children with diffuse fatty infiltration of the liver[J].Eur J Radiol,2009,71(3):552.
[5] 中华医学会肝脏病学分会脂肪肝和乙醇性肝病学组.非乙醇性脂肪肝诊断标准[J].中华肝脏病杂志,2003,11(2):7.
[6] Palau R,Mal F,Christidis C,et al.Transient elastrography a new non invasive method for assessment of liver fibrosis:Results in patients with HCV chronic hepatitis[J].Journal of Hepatology,2003,38(3):126.
[7] Sasso M,Tengher-Barna I,Ziol M,et al.Novel controlled attenuation parameter for noninvasive assessment of steatosis using Fibroscan(?):validation in chronic hepatitis C[J].Journal of Viral Hepatitis,2012,19(4):244.
[8] 顾国进,殷民德,郑松柏.实用内科学[M].上海:上海科学技术文献出版社,2004:243.
[9] Kinner S,Reeder S B,Yokoo T.Quantitative Imaging Biomarkers of NAFLD[J].Digestive Diseases & Sciences,2016,61(5):1337.
[10] Koplay M,Sivri M,Erdogan H,et al.Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease[J].World Journal of Hepatology,2015,7(5):769.
[11] Nalbantoglu I,Brunt E M.Role of liver biopsy in nonalcoholic fatty liver disease[J].World Journal of Gastroenterology,2014,20(27):9026.
[12] Yoshio,Sumida,Atsushi,et al.Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis[J].World Journal of Gastroenterology,2014,20(2):475.
[13] 王丽红.超声检查在脂肪肝诊断中的价值[J].吉林医学,2010,31(23):3879.
[14] Palmentieri B,de Sio I,La Mura V,et al.The role of bright liver echo pattern on ultrasound in the diagnosis of liver steatosis [J].Liver Dis,2006,38(7):485.
[15] DASARATHY S,DASARATHY J,KHIYAMI A,et al.Validity of real time ultrasound in the diagnosis of hepatic steatosis:a prospective study[J].J Hepatol,2009,51(6):1061.
[16] KHOV N,SHARMA A,RILFY TR.Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease[J].World J Gastroenterol ,2014,20(22):6821.
[17] SASSO M,BEAUGRAND M,de LEDINGHEN V,et al.Controlled attenuation parameter(CAP):a novel VCTMTM guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis:preliminary study and validation in a cohort of patients with chronic liver disease from various causes[J].Ultrasound Med Biol,2010,36(11):1825.
[18] Yilmaz Y,Ergelen R,Akin H,et al.Noninvasive detection of hepatic steatosis in patients without ultrasonographic evidence of fatty liver using the controlled attenuation parameter evaluated with transient elastography[J].European Journal of Gastroenterology & Hepatology,2013,25(11):1330.
[19] Chon Y E,Jung K S,Kim S U,et al.Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases:a prospective study of a native Korean population[J].Liver International,2013,34(1):102.
[20] 张旻.肝静脉多普勒频谱与乙醇性肝病的相关性研究[J].吉林医学,2014,35(13):2832.
[21] 管湘平,高燕华.不同程度脂肪肝的肝静脉血流频谱变化[J].中国临床保健杂志,2009,12(3):228.
[22] 金玲,丁虹,富凤萍.海勤人员非酒精性脂肪肝门静脉血流动力学改变的观察[J].人民军医,2011,54(4):273.
[23] 李保启,许红强,王金萍,等.彩色多普勒超声检测非酒精性脂肪肝患者血流动力学变化的应用价值研究,Chinese General Practice,2013,16(1):130.