杨　硕，吕　栋，王天懿，张龙友，徐有青

·脂肪性肝病·

杨硕，吕栋，王天懿，张龙友，徐有青

目的评价FibroTouchR脂肪衰减参数对非酒精性脂肪性肝病（NAFLD）患者肝脏脂肪变程度的诊断价值。方法纳入NAFLD患者86例和健康人90例，根据肝脏B超结果进行肝脏脂肪变分度（轻度43例、中度28例和重度15例）。使用FibroTouchR检查进行脂肪衰减参数和肝脏硬度值检测。构建受试者工作特征（ROC）曲线，计算曲线下面积（AUC），确定脂肪衰减参数对轻、中、重度肝脏脂肪变的诊断截断点，计算敏感度和特异度。结果健康人与NAFLD患者BMI分别为[（22.9±2.1）kg/m2和（27.8±3.4）kg/m2，P＜0.001]，脂肪衰减为[（215.1±16.3）db/m和（263.0±25.1）db/m，P＜0.001]，肝脏硬度为[（5.1±1.1）Kpa和（8.8±5.7）Kpa，P＜0.001]；轻度、中度和重度脂肪肝患者脂肪衰减分别为[（244.0±9.9）db/m、（273.8±9.7）db/m和（301.9±20.1）db/m，P＜0.001]；脂肪衰减与BMI（r=0.741，P＜0.001）和肝脏硬度（r=0.442，P＜0.001）呈正相关；脂肪衰减诊断轻度、中度和重度脂肪肝的AUC分别为0.935、0.986和0.969（P＜0.001），其对应的诊断截断点分别为237 db/m（敏感度96.7%，特异度86.4%）、259 db/m（敏感度97.7%，特异度92.9%）和286 db/m（敏感度96.4%，特异度93.3%）。结论FibroTouchR脂肪衰减参数可以无创、快速、客观地诊断NAFLD患者的肝脏脂肪变程度。

非酒精性脂肪性肝病；FibroTouchR；脂肪衰减参数；肝脏脂肪变

【Abstract】ObjectiveTo evaluate the diagnostic value of FibroTouchRby fat attenuation index（FAI）in patients with non-alcoholic fatty liver diseases（NAFLD）.MethodsA total of 86 patients with NAFLD and 90 healthy persons were recruited in this study.NAFLD group was divided into mild，moderate and severe liver steatosis based on B-ultrasonography.Two independent sample t-test was used to compare body mass index（BMI），FAI and liver stiffness were obtained by FibroTouchRbetween NAFLD group and healthy control.Oneway analysis of variance was used to compare above parameters among mild，moderate and severe liver steatosis. Pearson correlation was used to analyze the relationship between FAI and BMI or liver stiffness.Receiver operating characteristic（ROC）curves were plotted，and the areas under the curves（AUC）were calculated.The cut-off values were defined by maximizing the sum of sensitivity and specificity（maximum Youden index）.Results Between control group and NAFLD group，BMI were[（22.9±2.1）kg/m2and（27.8±3.4）kg/m2，P＜0.001]，FAI were [（215.1±16.3）db/m and（263.0±25.1）db/m，P＜0.001]，liver stiffness were[（5.1±1.1）Kpa and（8.8±5.7）Kpa，P＜0.001]；Among mild（n=43），moderate（n=28），severe（n=15）liver steatosis，FAI showed significant difference[（244.0± 9.9）db/m，（273.8±9.7）db/m and（301.9±20.1）db/m，P＜0.001]；FAI showed positive correlation with BMI（r= 0.741，P＜0.001）and liver stiffness（r=0.442，P＜0.001）；AUC of normal vs.mild，mild vs.moderate，and moderate vs.severe were（0.935，0.986，and 0.969，respectively，P＜0.001）；The cut-off values for mild，moderate，and severe liver steatosis were 237 db/m（sensitivity 96.7%，specificity 86.4%），259 db/m（se.97.7%，sp.92.9%），and 286 db/m（se.96.4%，sp.93.3%），respectively.ConclusionFAI shows advantages in diagnosing NAFLD，and has a promising diagnostic potential for grading liver steatosis in patients with NAFLD.

【Key words】Non-alcoholic fatty liver diseases；FibroTouchR；Fat attenuation index；Liver steatosis

非酒精性脂肪性肝病（NAFLD）是一系列代谢应激性肝脏损伤的总称[1]。NAFLD现已成为欧美等发达国家和我国富裕地区慢性肝病的重要病因。世界范围发病率为6.3%～33%，平均为20%[2]，欧美发病率为20%～33%[3]。我国上海、广州、香港发病率约为15%[1]。肝组织活检是诊断肝脏脂肪变程度的金标准，但是该诊断方法因为有创、可能出现并发症等缺点而不能被广泛应用[4，5]。临床上，B超检查在NAFLD的诊断及分度上应用较广泛，但容易受受检者因素和检查者临床经验的影响，其准确性较差[6]。……