Could semiquantitative analysis of real-time ultrasound elastography distinguish more liver parenchyma alterations of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome?

ABSTRACT Objective: Nonalcoholic fatty liver disease is the commonest diffuse liver disease, of which women with polycystic ovary syndrome are at an increased risk. The aim of the present study was to assess the diagnostic value of the semiquantitative strain parameters of real-time ultrasound elastography for nonalcoholic fatty liver disease in patients with polycystic ovary syndrome. Subjects and methods: Thirty-five polycystic ovary syndrome patients with nonalcoholic fatty liver disease, 70 polycystic ovary syndrome patients without nonalcoholic fatty liver disease, and 70 healthy female controls of reproductive age were included. All participants underwent ultrasonic examination and semiquantitative analysis of real-time ultrasound elastography of the liver. Results: Main semi quantitative strain parameters, such as average strain value, differed significantly among groups polycystic ovary syndrome with nonalcoholic fatty liver disease, polycystic ovary syndrome without nonalcoholic fatty liver disease, and control (87.02 ± 10.16 vs. 96.31 ± 11.44 vs. 104.49 ± 7.28, p < 0.001). Clinical and laboratory parameters differed significantly between the two subgroups with low or high average strain value. For diagnostic value of average strain value for elevated aminotransferase, the area under the curve was 0.808 (range 0.721-0.895). In multiple linear regression analysis, polycystic ovary syndrome, waist circumference, and metabolic syndrome were stand-alone independent factors associated with average strain value among subjects without nonalcoholic fatty liver disease. Conclusion: Semiquantitative real-time ultrasound elastography analysis could distinguish liver parenchyma alterations in patients with polycystic ovary syndrome more sensitively. The diagnostic value of the proposed method for nonalcoholic fatty liver disease need further research.

摘要
研究目的：非酒精性脂肪性肝病（nonalcoholic fatty liver disease）是临床最常见的弥漫性肝脏疾病，合并多囊卵巢综合征（polycystic ovary syndrome）的女性患病风险显著升高。本研究旨在评估实时超声弹性成像（real-time ultrasound elastography）的半定量应变参数（semiquantitative strain parameters）对多囊卵巢综合征患者合并非酒精性脂肪性肝病的诊断价值。

研究对象与方法：本研究纳入35例合并非酒精性脂肪性肝病的多囊卵巢综合征患者、70例未合并非酒精性脂肪性肝病的多囊卵巢综合征患者，以及70例育龄期健康女性对照。所有受试者均接受肝脏超声检查及实时超声弹性成像半定量分析。

结果：主要半定量应变参数（如平均应变值）在三组（合并非酒精性脂肪性肝病的多囊卵巢综合征患者、未合并非酒精性脂肪性肝病的多囊卵巢综合征患者及健康对照）间存在显著统计学差异（87.02±10.16 vs 96.31±11.44 vs 104.49±7.28，p<0.001）。按平均应变值高低划分的两个亚组间，临床及实验室参数均存在显著差异。针对氨基转移酶升高的诊断，平均应变值的曲线下面积为0.808（范围0.721~0.895）。多因素线性回归分析显示，在未合并非酒精性脂肪性肝病的受试者中，多囊卵巢综合征、腰围及代谢综合征是与平均应变值相关的独立相关因素。

结论：实时超声弹性成像半定量分析可更灵敏地鉴别多囊卵巢综合征患者的肝脏实质改变。本方法用于非酒精性脂肪性肝病的诊断价值仍需进一步研究。