CAJ | 학술논문

目的：探讨 FibroTouch 脂肪衰减参数对 CHB 合并非酒精性脂肪性肝病（NAFLD）患者的诊断价值。方法2014年1月至2015年3月河南省人民医院感染性疾病科收治的 CHB 患者115例为研究对象，分为单纯 CHB 组61例及 CHB 合并 NAFLD 组54例，分析 FibroTouch 在肝脏炎性反应、纤维化及脂肪肝的诊断价值及相关因素的关系，对其中的计量资料采用 t 检验，组间差异采用单因素方差分析，对其中的计数资料采用χ2检验。结果115例患者肝脏硬度值为（8．22±6．33）kPa，脂肪衰减参数为（242．37±31．56）db／m，CHB 合并 NAFLD 组患者脂肪衰减参数、体质指数（BMI）、总胆固醇、三酰甘油和血糖均高于单纯 CHB 组，差异均有统计学意义（均 P ＜0．05）。54例 CHB 合并 NAFLD 组患者，依据脂肪变程度分为轻度、中度、重度，结果显示脂肪变程度越重脂肪衰减参数就越高（P ＜0．05），且脂肪衰减参数的敏感度为92．6％，特异度为85．0％。在相同的炎性反应及纤维化程度上，CHB 合并NAFLD 组患者脂肪衰减参数均高于单纯 CHB 组患者，差异均有统计学意义（均P ＜0．05）。而各组患者的脂肪衰减参数在不同的炎症分级（χ2＝5．901，P ＝0．117）及纤维化分期（χ2＝4．073，P ＝0．254）中的差异无统计学意义。结论 FibroTouch 作为一种新的无创性诊断方式，可以较好地反映 CHB 患者的脂肪变程度，推荐应用于 CHB 合并 NAFLD 患者的临床诊治。
목적：탐토 FibroTouch 지방쇠감삼수대 CHB 합병비주정성지방성간병（NAFLD）환자적진단개치。방법2014년1월지2015년3월하남성인민의원감염성질병과수치적 CHB 환자115례위연구대상，분위단순 CHB 조61례급 CHB 합병 NAFLD 조54례，분석 FibroTouch 재간장염성반응、섬유화급지방간적진단개치급상관인소적관계，대기중적계량자료채용 t 검험，조간차이채용단인소방차분석，대기중적계수자료채용χ2검험。결과115례환자간장경도치위（8．22±6．33）kPa，지방쇠감삼수위（242．37±31．56）db／m，CHB 합병 NAFLD 조환자지방쇠감삼수、체질지수（BMI）、총담고순、삼선감유화혈당균고우단순 CHB 조，차이균유통계학의의（균 P ＜0．05）。54례 CHB 합병 NAFLD 조환자，의거지방변정도분위경도、중도、중도，결과현시지방변정도월중지방쇠감삼수취월고（P ＜0．05），차지방쇠감삼수적민감도위92．6％，특이도위85．0％。재상동적염성반응급섬유화정도상，CHB 합병NAFLD 조환자지방쇠감삼수균고우단순 CHB 조환자，차이균유통계학의의（균P ＜0．05）。이각조환자적지방쇠감삼수재불동적염증분급（χ2＝5．901，P ＝0．117）급섬유화분기（χ2＝4．073，P ＝0．254）중적차이무통계학의의。결론 FibroTouch 작위일충신적무창성진단방식，가이교호지반영 CHB 환자적지방변정도，추천응용우 CHB 합병 NAFLD 환자적림상진치。
Objective To explore the diagnostic value of FibroTouch fat attenuation parameter in patients with chronic hepatitis B (CHB)complicated with nonalcoholic fatty liver disease (NAFLD). Methods One hundred and fifteen CHB patients hospitalized in He′nan Provincial People′s Hospital from Jan 2014 to Mar 2015 were divided into two groups:61 CHB only and 54 complicated with NAFLD.The diagnostic value and related factors of FibroTouch in liver inflammation,fibrosis and fatty liver disease were analyzed.Student t test was used in quantitative data analysis,and difference between groups was analyzed by using one-way analysis of variance (ANOVA).The qualitative data were compared by chi-square test.Results In 115 patients,the liver stiffness value was (8.22 ±6.33 )kPa,fat attenuation parameter was (242.37±31 .56)db/m.The fat attenuation parameters,body mass index (BMI),total cholesterol,triacylglycerol and glucose of CHB patients with NAFLD group were higher than those of CHB group,with statistically significant differences (all P <0.05).Fifty-four patients diagnosed with CHB complicated with NAFLD were divided into mild,moderate and severe subgroups according to the degree of liver fat.The fat attenuation parameter increased along with the degree of liver fat (P <0.05). The sensitivity of fat attenuation parameter was 92.6% and the specificity was 85 .0%.In same grades of fibrosis and inflammation,the fat attenuation parameter of patients with CHB complicated with NAFLD was higher than patients with CHB only,with statistically significant difference (P <0.05 ).However,there were no statistically significant differences of fat attenuation parameter with different degree of liver inflammation (χ2 = 5 .901 ,P = 0.117 )and fibrosis (χ2 = 4.073,P = 0.254 )in the two groups. Conclusions As a new noninvasive diagnostic method,FibroTouch can reflect the degree of fat of the liver, which could be recommended as the clinical diagnosis tool for CHB complicated with NAFLD patients.