目的 分析超声衰减参数(UAP)联合血清纤溶酶原激活物抑制物1(PAI-1)和丙氨酸氨基转移酶(ALT)水平评估代谢相关性脂肪性肝病(MAFLD)患者肝脂肪变性程度的效能.方法 2019 年 3 月~2022 年 12 月我院诊治的112 例MAFLD患者均接受肝穿刺活检,所有受试者接受iLivTouch瞬时弹性成像检测UAP,采用ELISA法检测血清PAI-1水平,应用受试者工作特征(ROC)曲线分析UAP联合血清PAI-1 和ALT水平评估MAFLD患者肝脂肪变性程度的效能.结果 在112 例MAFLD患者中,经肝组织病理学检查发现肝脂肪变1 级(轻度)45 例,2 级(中度)42 例和 3 级(重度)25例;重度肝脂肪变患者BMI、血清TC、TG和LDL-C水平分别为(32.6±2.4)kg/m2、(6.6±0.9)mmol/L、(4.6±1.4)mmol/L和(4.0±0.9)mmol/L,显著高于中度患者[分别为(27.6±1.9)kg/m2、(5.8±0.8)mmol/L、(3.5±0.9)mmol/L和(3.5±0.7)mmol/L,P<0.05]或轻度患者[分别为(24.1±0.9)kg/m2、(5.1±0.7)mmol/L、(2.2±0.7)mmol/L和(3.0±0.5)mmol/L,P<0.05],而血清HDL-C水平为(1.2±0.2)mmol/L,显著低于中度[(1.4±0.2)mmol/L,P<0.05]或轻度患者[(1.4±0.2)mmol/L,P<0.05];重度组UAP、血清PAI-1 和ALT水平分别为(312.7±32.6)dB/m、(36.5±4.2)mg/mL和(72.1±7.4)U/L,显著高于中度组[分别为(284.2±30.1)dB/m、(28.1±3.4)mg/mL和(36.3±4.1)U/L,P<0.05]或轻度组[分别为(257.4±26.4)dB/m、(20.4±2.4)mg/mL和(23.7±2.5)U/L,P<0.05];ROC曲线分析显示,UAP联合血清PAI-1 和ALT水平评估重度肝脂肪变性的曲线下面积(AUC)、特异度和敏感度分别为 0.914(95%CI:0.883~0.990)、89.6%和 93.3%,其特异度显著优于单一指标预测(P<0.05).结论 应用UAP联合血清PAI-1 和ALT水平预测MAFLD患者严重肝脂肪变性有良好的评估价值,可为临床诊治提供参考依据.
Objective This study was conducted to investigate the diagnostic performance of ultrasound attenuation parameter(UAP)combined with serum plasminogen activator inhibitor-1(PAI-1)and alanine aminotransaminase(ALT)levels in evaluating severe hepatic steatosis in patients with metabolic associated fatty liver disease(MAFLD).Methods 112 patients with MAFLD were admitted to our hospital between March 2019 an December 2022,and all patients underwent liver biopsy and transient elastography for UAP detection.Serum PAI-1 level was measured by ELISA.The diagnostic efficacy was analyzed by using the receiver operating characteristic(ROC)curve.Results Out of the 112 patients with MAFLD,the liver histopathological examination showed mild liver steatosis in 45 cases,moderate in 42 cases and severe in 25 cases;the BMI,serum TC,TG and LDL-C levels in patients with severe liver steatosis were(32.6±2.4)kg/m2,(6.6±0.9)mmol/L,(4.6±1.4)mmol/L and(4.0±0.9)mmol/L,significantly higher than[(27.6±1.9)kg/m2,(5.8±0.8)mmol/L,(3.5±0.9)mmol/L and(3.5±0.7)mmol/L,respectively,P<0.05]in patients with moderate or[(24.1±0.9)kg/m2,(5.1±0.7)mmol/L,(2.2±0.7)mmol/L and(3.0±0.5)mmol/L,respectively,P<0.05]in mild,while serum HDL-C level was(1.2±0.2)mmol/L,significantly lower than[(1.4±0.2)mmol/L,P<0.05]in moderate or[(1.4±0.2)mmol/L,P<0.05]in mild liver steatosis;the UAP,serum PAI-1 and ALT level in patients with severe steatosis were(312.7±32.6)dB/m,(36.5±4.2)mg/mL and(72.1±7.4)U/L,much higher than[(284.2±30.1)dB/m,(28.1±3.4)mg/mL and(36.3±4.1)U/L,P<0.05]in moderate or[(257.4±26.4)dB/m,(20.4±2.4)mg/mL and(23.7±2.5)U/L,P<0.05]in mild steatosis;the ROC analysis showed that the AUC,sensitivity(Se)and specificity(Sp)were 0.914(95%CI:0.883-0.990),89.6%and 93.3%,with the Sp superior to any single parameter evaluation(P<0.05)by the combination of UAP and serum PAI-1 and ALT level in predicting severe liver steatosis.Conclusion We recommend the combination of UAP and serum PAI-1 and ALT level in predicting severe hepatic steatosis in patients with MAFLD,which might provide a scientific clue for clinical management.