超声预测慢性乙型肝炎患者的肝脂肪变性

StephenW

J Ultrasound Med. 2017 Feb 2. doi: 10.7863/ultra.16.04076. [Epub ahead of print]
Sonography Predicts Liver Steatosis in Patients With Chronic Hepatitis B.Kelly EM1, Feldstein VA2, Etheridge D3, Hudock R4, Peters MG5.
Author information

• 1Division of Gastroenterology and Hepatology, University of Ottawa, Ottawa, Ontario, Canada.
• 2Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
• 3The Ottawa Hospital, Ottawa, Ontario, Canada.
• 4Division of Pharmacy, University of California, San Francisco, California, USA.
• 5Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA.
  

AbstractOBJECTIVES: Liver inflammation and fibrosis may impair the ability of sonography to identify steatosis. We determined the accuracy of sonography in grading steatosis in patients with chronic hepatitis B compared to liver biopsy.
METHODS: We conducted was a single-center retrospective study of all nontransplanted patients with chronic hepatitis B undergoing sonography and liver biopsy between 2004 and 2014 (n = 109). Steatosis was graded by sonography as none, mild, moderate, or severe. Liver histologic analysis graded steatosis (0, <5%; 1, <33%; 2, <66%; or 3, ≥66%) and staged fibrosis (F0-F4). Severe steatosis was defined as grade 2 or 3. Clinical variables within 6 months of liver biopsy were collected, and the association with steatosis was analyzed by univariate logistic regression.
RESULTS: Patients were predominantly Asian (83%), male (62%), and hepatitis B e antigen negative (62%). Twenty-nine percent of patients were obese; 9% had diabetes mellitus; 23% had hypertension; and 31% had dyslipidemia. Forty-four percent of patients had steatosis on liver biopsy; 8% had severe steatosis. The presence of any steatosis on sonography correctly identified any steatosis on liver biopsy in 29 of 48 patients (60%). The absence of steatosis on sonography ruled out severe steatosis on biopsy (specificity, 100%). Severe steatosis on sonography correctly predicted the presence of severe steatosis on liver biopsy (89%; P < .001); however, it was not accurate at distinguishing between steatosis grades. Predictors of biopsy-proven steatosis on univariate analysis included diabetes (P < .001), hypertension (P = .03), hypercholesterolemia (P = .02), and body mass index (P < .001).
CONCLUSIONS: Sonography had excellent accuracy in identifying patients with steatosis on biopsy. Abdominal sonography can be used to predict clinically important steatosis in patients with chronic hepatitis B.

© 2017 by the American Institute of Ultrasound in Medicine.

KEYWORDS: fatty liver; gastrointestinal ultrasound; hepatitis B virus; liver biopsy; sonography

PMID:28151547DOI:10.7863/ultra.16.04076

StephenW

J Ultrasound Med。 2017年2月2. doi：10.7863 / ultra.16.04076。 [打印前的电子版]
超声预测慢性乙型肝炎患者的肝脂肪变性
Kelly EM1，Feldstein VA2，Etheridge D3，Hudock R4，Peters MG5。
作者信息

    渥太华大学，加拿大安大略省渥太华大学胃肠病学和肝病学。
    2放射学和生物医学成像部，加利福尼亚大学，旧金山，加利福尼亚，美国。
    3渥太华医院，渥太华，安大略省，加拿大。
    加利福尼亚大学，旧金山，加利福尼亚，美国药学学士学位。
    加利福尼亚大学，旧金山，加利福尼亚，美国的胃肠病学和肝病学。

抽象
目标：

肝脏炎症和纤维化可能损害超声检查鉴定脂肪变性的能力。我们确定在慢性乙型肝炎患者分级脂肪变性的超声检查的准确性比肝活检。
方法：

我们进行了一项单中心回顾性研究，所有未移植的慢性乙型肝炎患者在2004 - 2014年间接受超声和肝活检（n = 109）。脂肪变性通过超声波检查分为无，轻度，中度或重度。肝组织学分析分级脂肪变性（0，<5％; 1，<33％; 2，<66％;或3，≥66％）和分期的纤维化（F0-F4）。严重脂肪变性定义为2级或3级。收集肝活检6个月内的临床变量，并通过单变量逻辑回归分析与脂肪变性的相关性。
结果：

患者主要是亚洲人（83％），男性（62％）和乙型肝炎e抗原阴性（62％）。二十九％的患者是肥胖; 9％有糖尿病; 23％有高血压;和31％具有血脂异常。 44％的患者在肝活检中有脂肪变性; 8％有严重脂肪变性。 48例患者中的29例（60％），在超声检查中任何脂肪变性的存在正确地识别了肝活检的任何脂肪变性。在超声检查中没有脂肪变性排除了活检的严重脂肪变性（特异性，100％）。严重脂肪变性在超声检查中正确预测肝活检中存在严重脂肪变性（89％; P <0.001）;然而，在区分脂肪变性等级方面不准确。单因素分析的活检证实的脂肪变性的预测因素包括糖尿病（P <0.001），高血压（P = 0.03），高胆固醇血症（P = .02）和体重指数（P <0.001）。
结论：

超声检查在确定活检脂肪变性患者方面具有极好的准确性。腹部超声检查可用于预测慢性乙型肝炎患者的临床重要脂肪变性。

©2017由美国超声医学研究所。
关键词：

脂肪肝;胃肠超声;乙型肝炎病毒;肝活组织检查;超声检查

PMID：
    28151547
DOI：
    10.7863 / ultra.16.04076