编者按：EASL2017期间，香港中文大学消化疾病研究所、内科及药物治疗学系Vincent W.-S. Wong教授在“Parallel session: Non invasive assessment of liver disease”专题中，报告了其团队完成的一项多中心研究：受控衰减参数（CAP）诊断脂肪肝的可信度标准分析（大会摘要号：PS-120）。

 

Wong教授在采访中指出，CAP可经瞬时弹性成像（TE）技术定量检测肝脏脂肪变情况，明确脂肪肝诊断，操作简便，比常规腹部超声诊断脂肪肝更灵敏。另外，CAP检测可与肝脏硬度测定（LSM）同时进行，即可通过一次FibroScan无创检查，既明确脂肪肝诊断又评估肝脏纤维化程度。但美中不足的是，CAP的准确度有所欠缺。为此，研究团队尝试确定一些标准，以便临床医生能够据此明确所获得检测结果是否可靠。

 

在纳入754例患者的多中心研究中，Wong教授团队发现，十次CAP检测的四分位范围（IQR）可以判断检测结果是否值得信赖。Wong教授认为这是一个可使用的简易算法，而且可直接应用于临床：当IQR＜40 dB/m时，依据CAP诊断脂肪肝的可信度更高；但当IQR≥40 dB/m时，检测的准确度下降，此时应谨慎解读CAP结果。另外，研究还发现影响LSM的传统因素对CAP的可信度几乎没有影响。“我非常开心，很多学者在会上自告奋勇地指出这是一个重要的研究，同时他们也提出了一些有趣的问题”，Vincent W.-S. Wong教授介绍到。

 

在谈及此次参会感想时，Wong教授认为，这是一次高水平的学术盛会，涵盖了肝病不同领域的顶级技术与最前沿信息。最令他欣喜的是，无创检测已开始应用于初级保健单位（如经全科医师）。他认为，这是非常重要的，因为大部分患者的初诊医生是全科医师，无创检测在基层的应用有助于一线医生明确脂肪肝诊断，及时咨询相关专家给予这些患者相应治疗。

 

英文原文：

 

At this EASL meeting, our group presented the validating criteria analysis for controlled attenuation parameter. Controlled attenuation parameter (CAP) is a measurement of liver fat. It is quite handy and easy to use, however, its accuracy is not perfect. We were trying to identify some criteria so that clinicians can determine whether a measurement is reliable. In our study of 754 patients, we were able to show that the interquartile range of ten measurements of CAP could determine whether the measurement is trustworthy. In particular, if the interquartile range exceeds 40 then accuracy declines and we should be more cautious when interpreting CAP results. We think that this is a simple algorithm to use and can be applied immediately at the clinic. I am quite happy that many people came forward at this meeting to say this was an important study, and they also raised some interesting questions as well.

 

The biggest advantage of CAP is that, firstly, it is more sensitive than a routine ultrasound scan of the abdomen in diagnosing fatty liver. At the same time, because CAP is measured together with liver stiffness by the FibroScan machine, fatty liver can be diagnosed as well as a simultaneous assessment of liver stiffness. It is not just for diagnosis, but also for the assessment of the liver. From a single investigation, a lot can be learned.

 

I am happy to say this is an excellent meeting, very well organized, with many sessions presenting the state-of-the-art and newest information from various aspects of hepatology. I am very glad to be here. We have heard a lot of new interesting studies at this meeting. At my session, there were six presentations on the various aspects of non-invasive diagnosis of liver disease. What I found exciting is that there is work starting in the primary care setting (i.e. by general practitioners). I think it is important to not just apply non-invasive tests in the hospital setting, but also in the primary care setting. Most patients are seeing their general practitioners. They are the people who see patients first and identify those at risk and then refer for specialist treatment. I think that is very important.