超声衍生脂肪分数对慢性肝病患者肝脂肪变分级的诊断效能：多中心研究
该前瞻性多中心研究以肝活检为参考标准，纳入255例慢性肝病患者，评估DAX探头测量的超声衍生脂肪分数（UDFF）对肝脂肪变分级的诊断效能。UDFF诊断≥S1、≥S2和=S3的AUC分别为0.914、0.950和0.916，最佳截断值分别为7%、11%和18%。研究结论认为UDFF在不同病因、坏死性炎症分期、纤维化分期及人体测量学指标亚组中均能良好检测和分级肝脂肪变。
要点
- UDFF诊断肝脂肪变≥S1、≥S2、=S3的AUC均>0.9，最佳截断值分别为7%、11%、18%。
- 在有无坏死性炎症、进展期纤维化及不同人体测量学指标亚组中，UDFF诊断≥S1的AUC均>0.9。
- UDFF可作为肝活检的无创替代方法用于慢性肝病患者肝脂肪变的定量评估和监测。
核心结论
- DAX探头测量的UDFF在慢性肝病患者中能极好地检测和分级肝脂肪变，不受病因、坏死性炎症分期、纤维化或人体测量学指标影响。
研究设计与样本
- 前瞻性多中心研究，纳入2024年10月至2025年6月间255例慢性肝病患者（平均年龄51.27岁±11.24，男148例），以肝活检为参考标准评估UDFF诊断效能。
诊断标准与关键数值
- UDFF诊断肝脂肪变≥S1的AUC为0.914（95%CI：0.873-0.946），最佳截断值7%（109例，42.75%）。
- UDFF诊断肝脂肪变≥S2的AUC为0.950（95%CI：0.916-0.974），最佳截断值11%（79例，30.98%）。
- UDFF诊断肝脂肪变=S3的AUC为0.916（95%CI：0.875-0.947），最佳截断值18%（39例，15.30%）。
- 在伴坏死性炎症（n=164）、进展期纤维化（n=61）、皮肤至肝包膜距离≥1.9 cm（n=129）、肋间距≤2.5 cm（n=162）及排除孤立性代谢功能障碍相关脂肪性肝病（n=178）亚组中，UDFF诊断≥S1的AUC均>0.9。
临床应用与阅片要点
- 日常可参考UDFF截断值7%、11%、18%分别提示≥S1、≥S2、=S3肝脂肪变，辅助无创分级和随访监测。
- 在慢性肝病伴坏死性炎症、进展期纤维化或特定人体测量学指标（皮肤至肝包膜距离≥1.9 cm、肋间距≤2.5 cm）患者中，UDFF诊断效能仍稳定。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To investigate the diagnostic performance of ultrasound-derived fat fraction (UDFF) using the DAX probe for evaluating hepatic steatosis in chronic liver disease (CLD) patients with liver biopsy. Possible influencing factors such as etiology, stage of necroinflammation, fibrosis, and anthropometric indices were also evaluated.
MATERIALS AND METHODS: This prospective multicenter study enrolled CLD patients between October 2024 and June 2025. The diagnostic performance of UDFF was evaluated by the area under the receiver-operating characteristic curve (AUC) with liver biopsy as the reference standard. Subgroup analysis was performed in different etiologies, stages of necroinflammation, fibrosis, and anthropometric indices.
RESULTS: Among the total of 255 patients (mean age, 51.27 years ± 11.24; 148 men), 146 (57.25%) had no steatosis (S0). The AUC of UDFF for detecting hepatic steatosis ≥ S1, ≥ S2, and = S3 were 0.914 (95% confidence interval (CI): 0.873-0.946), 0.950 (95% CI: 0.916-0.974), and 0.916 (95% CI: 0.875-0.947), respectively. The optimal cutoff values were: 7% for ≥ S1 (109, 42.75%), 11% for ≥ S2 (79, 30.98%), and 18% for = S3 (39, 15.30%). UDFF also demonstrated AUC > 0.9 for detecting hepatic steatosis ≥ S1 in following subgroups: (1) with necroinflammation (n = 164); (2) with advanced fibrosis (n = 61); (3) with skin-to-capsule distance ≥ 1.9 cm (n = 129); (4) with intercostal distance ≤ 2.5 cm (n = 162); (5) excluding isolated metabolic dysfunction-associated steatotic liver disease (n = 178).
CONCLUSION: UDFF measured with the DAX probe excellently detected and graded hepatic steatosis in CLD patients regardless of etiology, stage of necroinflammation, fibrosis, or anthropometric indices.
KEY POINTS: Question Can UDFF reliably grade hepatic steatosis in CLD patients, regardless of etiology, necroinflammation, or fibrosis? Findings In this mixed-etiology population of 255 CLD patients, UDFF demonstrated high diagnostic performance for grading steatosis, consistent across diverse etiologies, necroinflammation, and fibrosis stages. Clinical relevance UDFF provides a reliable alternative to liver biopsy for quantifying hepatic steatosis in CLD, enabling accurate diagnosis and timely monitoring without invasive procedures.
引用
- Han J, Yang L, Chu L, et al. Diagnostic performance of ultrasound-derived fat fraction for grading hepatic steatosis in patients with chronic liver diseases: a multicenter study. Eur Radiol. 2026. PMID: 42045510. doi:10.1007/s00330-026-12574-9
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。