多参数超声一站式评估慢性乙型肝炎肝纤维化、炎症与脂肪变的前瞻性研究
前瞻性纳入146例慢性乙型肝炎患者，行肝硬度、剪切波色散斜率与衰减系数多参数超声并对照肝活检。肝硬度诊断≥F2和F4优于色散斜率，衰减系数诊断脂肪变≥S1的AUC为0.933且不受BMI影响，但色散斜率诊断纤维化受ALT升高影响。
要点
- 肝硬度是评估CHB肝纤维化的首选超声参数，诊断F4的AUC达0.92。
- 衰减系数诊断脂肪变≥S1的AUC为0.933，不同BMI患者中表现一致。
- ALT≥2倍正常上限时色散斜率诊断F4的AUC显著下降，判读需谨慎。
局限性
- 单中心前瞻性研究，样本量146例，结论外推需多中心验证。
- 未报告炎症活动度的具体诊断阈值和分级标准。
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
OBJECTIVE: To evaluate a multiparameter ultrasound protocol combining liver stiffness (LS), shear-wave dispersion slope (DS), and attenuation coefficient (AC) measurements for noninvasive, one-stop assessment of liver fibrosis, inflammatory activity, and steatosis in chronic hepatitis B (CHB), and to analyze the influence of alanine transaminase (ALT) levels and body mass index (BMI) on the diagnostic accuracy.
MATERIALS AND METHODS: This prospective study enrolled 146 patients with CHB who underwent the ultrasound protocol and liver biopsy. Correlations with histological findings and diagnostic performance were analyzed, and stratified analyses by ALT levels and BMI categories were performed.
RESULTS: LS showed superior diagnostic performance for ≥F2 (area under the curve [AUC]: 0.83 vs. 0.74, P = 0.014) and F4 (AUC: 0.92 vs. 0.73, P = 0.001) than DS. In comparison with the ALT < 2 ULN group, the ALT ≥ 2 ULN group showed decreasing AUCs of DS for diagnosing ≥F2 (0.778 vs. 0.572, P = 0.075) and a significant decrease for F4 (0.829 vs. 0.603, P = 0.045). In contrast, the AUCs of LS for diagnosing ≥F2 (0.836 vs. 0.728, P = 0.279) and F4 (0.961 vs. 0.858, P = 0.142) did not differ significantly between the ALT subgroups. AC showed good diagnostic performance for steatosis grade ≥S1 (AUC: 0.933) and this was consistent across patients with different BMI.
CONCLUSION: The multiparameter ultrasound protocol allowed comprehensive, one-stop assessment of liver pathology in CHB. AC showed good diagnostic performance for steatosis grade ≥S1 and this was consistent across patients with different BMI. However, the diagnostic performance of DS for detecting fibrosis was susceptible to elevated ALT levels.
引用
- Zhou HY, Ding JM, Zhou Y, et al. Prospective study of multiparameter ultrasound for one-stop assessment of liver fibrosis, inflammation, and steatosis in patients with chronic hepatitis B. Eur J Radiol. 2026. PMID: 42085770. doi:10.1016/j.ejrad.2026.112901
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。