慢性乙型肝炎患者肝脏脂肪变性无创诊断方法的比较

Comparison of Non-Invasive Diagnostic Tools for Steatosis of Chronic Hepatitis B

摘要: 目的：比较无创检查方法对慢性乙型肝炎患者肝脏脂肪变性的诊断价值。方法：回顾性收集延安大学附属医院2018年10月至2022年4月行肝活检、受控衰减参数(CAP)和磁共振质子密度脂肪分数(MRI-PDFF)检查的慢性乙型病毒性肝炎患者56例。按肝脂肪变性病理学结果分为2组：无脂肪变性组(42例)、有脂肪变性组(14例)。使用受试者工作特征曲线(ROC)评估肝脏脂肪变性指数(HSI)、受控衰减参数(CAP)和磁共振质子密度脂肪分数(MRI-PDFF)对肝脏脂肪变性的诊断效能，并使用DeLong检验进行比较。结果：两组之间的BMI、ALT、AST、GGT、HDL-C、LDL-C、LSM、HSI、CAP、MRI-PDFF差异有统计学意义。ROC曲线分析结果显示HSI、CAP、MRI-PDFF曲线下面积分别为0.811、0.897、0.968，MRI-PDFF对肝脂肪变性的诊断效能优于HSI和CAP。DeLong检验结果显示，MRI-PDFF检测肝脏脂肪变性的表现明显优于HSI。结论：HSI、CAP、MRI-PDFF在检测慢性乙肝患者肝脏脂肪变性方面均具有良好的诊断效能，MRI-PDFF比HSI和CAP更准确。

Abstract: Objective: To compare the value of non-invasive examination in the diagnosis of hepatic steatosis in patients with chronic hepatitis B. Methods: 56 patients with chronic hepatitis B were examined by liver biopsy, controlled attenuation parameter (CAP) and magnetic resonance proton density fat fraction (MRI-PDFF) from October 2018 to April 2022. According to the pathology results of hepatic steatosis, the patients were divided into two groups: non-steatosis group (n = 42) and steatosis group (n = 14). The receiver operating characteristic (ROC) curve was used to evaluate the diagnos-tic efficacy of hepatic steatosis index (HSI), controlled attenuation parameter (CAP) and magnetic resonance proton density fat fraction (MRI-PDFF), and compared with DeLong test. Results: There were significant differences in BMI, ALT, AST, GGT, HDL, LDL, LSM, HSI, CAP and MRI-PDFF between the two groups. The results of ROC curve analysis showed that the areas under HSI, CAP and MRI-PDFF curves were 0.811, 0.897 and 0.968, respectively. The diagnostic efficacy of MRI color PDFF was better than that of HSI and CAP in the diagnosis of hepatic steatosis. The results of DeLong test showed that MRI-PDFF was significantly better than HSI in the detection of hepatic steatosis. Conclusion: HSI, CAP and MRI-PDFF have good diagnostic efficacy in detecting hepatic steatosis in patients with chronic hepatitis B, and MRI-PDFF is more accurate than HSI and CAP.