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。
Objective To investigate the application value of liver/spleen CT value(CTL/S),controlled attenuation parameter(CAP),and magnetic resonance imaging-proton density fat fraction(MRI-PDFF)in chronic hepatitis B(CHB)patients with hepatic steatosis.Methods A retrospective analysis was performed for the clinical data of 213 CHB patients who underwent liver CT,CAP,and MRI-PDFF examinations in Affiliated Hospital of Yan’an University from October 2018 to December 2022.According to MRI-PDFF,the 213 patients were divided into CHB group with 111 patients(MRI-PDFF<5%)and CHB+hepatic steatosis group with 102 patients(MRI-PDFF≥5%),among whom there were 69 patients with mild hepatic steatosis and 33 patients with moderate to severe hepatic steatosis.The independent-samples t test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups.The Bland-Altman plot was used to evaluate the consistency in MRI-PDFF measurement between two physicians.The Spearman’s correlation coefficient was used to analyze the correlation between CTL/S and MRI-PDFF and between CAP and MRI-PDFF.The receiver operating characteristic(ROC)curve was plotted and the area under the ROC curve(AUC)was calculated to investigate the value of CTL/S and CAP in the diagnosis of different degrees of hepatic steatosis,and the DeLong test was used to compare the AUCs of the two radiological examinations.Results MRI-PDFF had relatively high repeatability and stability in CHB patients.There is a significant negative correlation between CTL/S and MRI-PDFF(r=−0.800,P<0.001)and a significant positive correlation between CAP and MRI-PDFF(r=0.692,P<0.001).Both CTL/S and CAP had a relatively high accuracy in the diagnosis of hepatic steatosis in CHB patients,with an AUC of 0.951 and 0.902,respectively,and CTL/S had a better accuracy than CAP(P<0.05).In the diagnosis of mild and moderate-to-severe hepatic steatosis,CTL/S had an AUC of 0.921 and 0.895,respectively,and CAP had an AUC of 0.859 and 0.825,respectively,suggesting that CTL/S had a slightly higher diagnostic efficiency than CAP.Conclusion MRI-PDFF has high repeatability and stability in CHB patients,and CTL/S and CAP have a high diagnostic value for different degrees of hepatic steatosis in CHB patients.
作者
鲁景楠
李岩松
温雅
王雄慧
屈兆宇
李建龙
张炜
LU Jingnan;LI Yansong;WEN Ya;WANG Xionghui;QU Zhaoyu;LI Jianlong;ZHANG Wei(Department of Medical Imaging,Affiliated Hospital of Yan’an University,Yan’an,Shaanxi 716000,China;Department of Nuclear Medicine,Xi’an International Medical Center Hospital,Xi’an 710100,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2024年第1期46-51,共6页
Journal of Clinical Hepatology
基金
延安市科学技术研究发展计划项目(2018KS-11)。
关键词
乙型肝炎
慢性
脂肪肝
诊断
Hepatitis B,Chronic
Fatty Liver
Diagnosis
