背景:非酒精性脂肪性肝病(NAFLD)包括从简单脂肪变性到纤维化和肝硬化的异质谱。纤维化,与长期总死亡率和肝脏相关事件相关,需要评估。传统上,肝活检一直是诊断纤维化的金标准。然而,它的侵入性,潜在的并发症,和采样变异性限制了广泛的使用。因此,已经开发了各种非侵入性试验作为诊断NAFLD患者纤维化的替代方法.
目的:本研究旨在比较非侵入性测试(NIT)的准确性,并评估声辐射力脉冲(ARFI)的诊断准确性,点剪切波技术之一,与传统方法相比,评估其在诊断中的有效作用。
方法:这是一项回顾性研究,共纳入136例经超声检查确诊为脂肪肝的患者。收集患者入院当天的人体测量数据和血液检查,ARFI的测量,使用腹部超声进行点剪切试验;第二天进行了活检.此外,我们基于4个因素(FIB-4)和NAFLD纤维化评分(NFS)计算了天冬氨酸转氨酶/血小板比值指数(APRI).随后,我们根据肥胖程度评估了不同亚组中NIT的诊断准确性,脂肪变性,或NAFLD活动得分。
结果:ARFI已被证明在各种NIT中具有最高的诊断价值,ARFI的AUROC值为0.832、0.794、0.767和0.696,APRI,FIB-4和NFS,分别。在病态肥胖亚组中,ARFI的AUROC值,APRI,FIB-4和NFS分别为0.805、0.769、0.736和0.674。在患有严重脂肪变性或非酒精性脂肪性肝炎(NASH)的组中,AUROC值分别为0.679、0.596、0.661和0.612,严重脂肪变性分别为0.789、0.696、0.751和0.691,对于NASH。
结论:结论:与血清NIT相比,ARFI不受各种因素的影响,并保持诊断准确性。因此,我们可以推荐ARFI作为一项有价值的诊断测试,用于筛查NAFLD患者的晚期纤维化.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) encompasses a heterogeneous spectrum ranging from simple steatosis to fibrosis and cirrhosis. Fibrosis, associated with long-term overall mortality and liver-related events, requires evaluation. Traditionally, liver biopsy has been the gold standard for diagnosing fibrosis. However, its invasive nature, potential complications, and sampling variability limit widespread use. Consequently, various non-invasive tests have been developed as alternatives for diagnosing fibrosis in NAFLD patients.
OBJECTIVE: This study aimed to compare the accuracy of non-invasive tests (NITs) and evaluate the diagnostic accuracy of acoustic radiation force impulse (ARFI), one of the point shear wave techniques, compared to conventional methods, assessing its effective role in diagnosis.
METHODS: This is a retrospective study; a total of 136 patients diagnosed with fatty liver disease through ultrasonography were enrolled. The anthropometric data of the patients were collected on the day of admission and blood tests, measurements of ARFI, and a point shear test were conducted using abdominal ultrasound; a biopsy was performed the following day. In addition, we calculated the aspartate aminotransferase-to-platelet ratio index (APRI) index based on four factors (FIB-4) and the NAFLD fibrosis score (NFS). Subsequently, we assessed the diagnostic accuracy of NITs within various subgroups based on the extent of obesity, steatosis, or NAFLD activity score.
RESULTS: ARFI has been shown to have the highest diagnostic value among various NITs, with AUROC values of 0.832, 0.794, 0.767, and 0.696 for ARFI, APRI, FIB-4, and NFS, respectively. In the morbidly obese subgroup, the AUROC values of ARFI, APRI, FIB-4, and NFS were 0.805, 0.769, 0.736, and 0.674. In the group with severe steatosis or non-alcoholic steatohepatitis (NASH), the AUROC values were 0.679, 0.596, 0.661, and 0.612, respectively, for severe steatosis and 0.789, 0.696, 0.751, and 0.691, respectively, for NASH.
CONCLUSIONS: In conclusion, ARFI is not affected by various factors and maintains diagnostic accuracy compared to serum NITs. Therefore, we can recommend ARFI as a valuable diagnostic test to screen for advanced fibrosis in patients with NAFLD.