评估肝脂肪变性严重程度时超声衰减参数的最佳阈值：一组

StephenW

Optimal thresholds for ultrasound attenuation parameter in the evaluation of hepatic steatosis severity: evidence from a cohort of patients with biopsy-proven fatty liver disease

Zhu, Sheng-Haoa; Zheng, Kenneth I.b; Hu, Di-Shuanga; Gao, Fenga; Rios, Rafael S.b; Li, Gangb; Li, Yang-Yangc; Byrne, Christopher D.d; Targher, Giovannie; Chen, Yong-Pingb,,f,,g; Zheng, Ming-Huab,,f,,gAuthor Information

aDepartment of Gastroenterology

bNAFLD Research Center, Department of Hepatology

cDepartment of Pathology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

dSouthampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK

eSection of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

fInstitute of Hepatology, Wenzhou Medical University

gKey Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China

Received 2 March 2020 Accepted 1 April 2020

Lay summary

Ultrasound attenuation parameter (UAP) generated by FibroTouch is an accurate tool to noninvasively detect and stage the presence of hepatic steatosis. Our proposed UAP cutoff values might be feasible in routine clinical practice.

Correspondence to Ming-Hua Zheng, MD, PhD, NAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou 325000, China, Tel: +86 577 55579622; fax: +86 577 55578522; e-mail: [email protected]
European Journal of Gastroenterology & Hepatology: March 2021 - Volume 33 - Issue 3 - p 430-435
doi: 10.1097/MEG.0000000000001746

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Abstract
Objective

FibroTouch is a newly developed device to assess ultrasound attenuation parameter (UAP) and liver stiffness measurement to quantify hepatic steatosis and fibrosis, respectively. However, there is currently a lack of defined thresholds of UAP to diagnose different stages of hepatic steatosis. We aimed to assess the optimal thresholds of UAP for hepatic steatosis in individuals with biopsy-proven fatty liver disease (FLD).
Methods

We enrolled 497 adults with FLD undergoing FibroTouch and liver biopsy. Area under the receiver operating characteristic curve (AUROC) was performed to calculate the performance of UAP in staging hepatic steatosis. Hepatic steatosis >33% was defined as significant steatosis. We determined the optimal cutoff values of UAP and the sensitivity or specificity higher than 90%. Sensitivity, specificity, positive predictive value and negative predictive value were subsequently calculated.
Results

The median UAP for the enrolled patients was 308 dB/m. Multivariable logistic regression analysis showed that UAP was associated with significant steatosis [adjusted-odds ratio 1.05, 95% confidence interval (CI), 1.02–1.09; P = 0.001]. The AUROCs for S ≥ 1, S ≥ 2 and S = 3 were 0.88 (95% CI, 0.84–0.91), 0.77 (95% CI, 0.73–0.81), and 0.70 (95% CI, 0.63–0.77), respectively. The optimal UAP cutoffs were 295 dB/m for S ≥ 1, 314 dB/m for S ≥ 2, and 324 dB/m for S = 3. Almost identical results were observed in the subgroup of patients with biopsy-confirmed nonalcoholic fatty liver disease (n = 435).
Conclusion

We found that the AUROC values of UAP by FibroTouch were ranging from 0.70 to 0.88 for assessing hepatic steatosis severity. These UAP cutoffs could be applicable for clinical use.
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

StephenW

评估肝脂肪变性严重程度时超声衰减参数的最佳阈值：一组经活检证实为脂肪肝病的患者的证据

朱胜浩；郑（Kenneth I.b）胡迪双；高丰Feng里奥斯（Raios）李刚李阳阳伯恩（Christopher D.d）；乔凡尼·塔格（Targher） Chen，Yong-Pingb ,, f ,, g; Zheng Ming-Huab，f，g作者信息

消化内科

bNAFLD肝病研究中心

c温州医科大学附属第一医院病理科，温州

d英国南安普敦市南安普顿总医院南安普敦大学医院南安普顿国家健康研究所生物医学研究中心

大学医学系内分泌，糖尿病和代谢科，意大利维罗纳维罗纳Azienda Ospedaliera Universitaria Integrata大学

温州医科大学肝病研究所

浙江省慢性肝病发展诊断与治疗重点实验室，温州

2020年3月2日收到2020年4月1日接受

放置摘要

FibroTouch生成的超声衰减参数（UAP）是无创检测和分阶段肝脂肪变性的准确工具。我们建议的UAP临界值在常规临床实践中可能是可行的。

通讯作者：温州医科大学附属第一医院肝病科郑明华医师，医学博士，NAFLD研究中心，河北温州325,000，电话：+86 577 55579622；传真：+86 577 55578522;电子邮件：[email protected]
欧洲胃肠病学和肝病学杂志：2021年3月-第33卷-第3期-第430-435页
doi：10.1097 / MEG.0000000000001746

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抽象
目的

FibroTouch是一种新开发的设备，用于评估超声衰减参数（UAP）和肝硬度测量，以分别量化肝脂肪变性和纤维化。然而，目前缺乏确定的UAP阈值来诊断肝脂肪变性的不同阶段。我们的目的是评估经活检证实为脂肪肝病（FLD）的肝脂肪变性的UAP最佳阈值。
方法

我们招募了497名接受FibroTouch和肝活检的FLD成人。进行受试者工作特征曲线（AUROC）下的面积以计算UAP在分期肝脂肪变性中的表现。肝脂肪变性> 33％被定义为严重脂肪变性。我们确定了UAP的最佳临界值，敏感性或特异性均高于90％。随后计算敏感性，特异性，阳性预测值和阴性预测值。
结果

入组患者的平均UAP为308 dB / m。多变量logistic回归分析显示，UAP与严重脂肪变性相关[调整赔率比1.05、95％置信区间（CI），1.02-1.09； P ＝ 0.001]。 S≥1，S≥2和S = 3的AUROC分别为0.88（95％CI，0.84-0.91），0.77（95％CI，0.73-0.81）和0.70（95％CI，0.63-0.77）。 。 S≥1的最佳UAP截止值为295 cutdB / m，S≥2的为314 dB / m，S cut = 3的为324 dB / m，在经活检证实为非酒精性脂肪肝的患者亚组中观察到几乎相同的结果。疾病（n = 435）。
结论

我们发现，通过FibroTouch评估UAP的AUROC值在0.70到0.88之间，以评估肝脂肪变性的严重程度。这些UAP临界值可能适用于临床用途。
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