彩色多普勒血流成像与剪切波弹性成像在非酒精性脂肪性肝病诊断及纤维化分期中的价值

doi:10.3877/cma.j.issn.2095-2015.2026.04.006

目的

探讨彩色多普勒血流成像（CDFI）与剪切波弹性成像（SWE）联合应用在非酒精性脂肪性肝病（NAFLD）诊断及纤维化分期中的价值。

方法

本研究为回顾性队列研究，选择西安交通大学附属红会医院2022年8月至2025年8月收治的80例NAFLD患者作为观察组，并选择同期本院体检的80例健康者作为对照组。比较两组肝脏CDFI检查参数[门静脉主干内径（PVD）、门静脉平均血流速度（PVVmean）、门静脉血流量（PVQ）、脾静脉内径（SVD）、脾静脉平均血流速度（SVVmean）、脾静脉血流量（SVQ）]及SWE（杨氏模量值），记录观察组肝纤维化发生情况，并比较不同肝纤维化程度患者肝脏CDFI检查参数、SWE结果，采用受试者工作特征曲线（ROC），分别分析肝脏CDFI、SWE对NAFLD及肝纤维化的诊断价值。

结果

观察组PVD、PVQ、SVD、SVQ、杨氏模量值均大于对照组，PVVmean、SVVmean均低于对照组（P<0.05）；观察组中肝纤维化分期S0期40例、S1期26例、S2期9例、S3期3例、S4期2例，不同肝纤维化分期患者PVD、PVVmean、PVQ、SVD、SVVmean、SVQ比较，差异均有统计学意义（P<0.05）。ROC分析显示，肝脏CDFI参数联合SWE诊断NAFLD的曲线下面积（AUC）均高于单独检测，且肝脏CDFI参数联合SWE诊断NAFLD患者肝纤维化的AUC均高于单独检测（P<0.05）。

结论

肝脏CDFI联合SWE对NAFLD及肝纤维化均有着较高的诊断价值，临床上应予以密切关注。

关键词: 非酒精性脂肪性肝病, 彩色多普勒血流成像, 门静脉, 脾静脉, 剪切波弹性成像, 诊断价值

Objective

To explore the value of the combined application of color Doppler flow imaging (CDFI) and shear wave elastography (SWE) in the diagnosis and fibrosis staging of non-alcoholic fatty liver disease (NAFLD).

Methods

This study was a retrospective cohort study. A total of 80 cases of patients with NAFLD admitted to Honghui Hospital, Xi'an Jiaotong University from August 2022 to August 2025 were selected as the observation group, and 80 healthy individuals who underwent physical examinations in our hospital during the same period were selected as the control group. The liver CDFI examination parameter [portal vein main inner diameter (PVD), portal vein mean blood flow velocity (PVVmean), portal vein blood flow (PVQ), splenic vein inner diameter (SVD), splenic vein mean blood flow velocity (SVVmean), splenic vein blood flow (SVQ)] and SWE (Young's modulus value) between the two groups were compared, the occurrence of liver fibrosis in the observation group was recorded, and the liver CDFI examination parameter and SWE results of patients with different degrees of liver fibrosis were compared. The receiver regression curve (ROC) was used to analyze the diagnostic value of liver CDFI and SWE for NAFLD and liver fibrosis respectively.

Results

The PVD, PVQ, SVD, SVQ and Young's modulus values in the observation group were greater than those in the control group, while the PVVmean and SVVmean were lower than those in the control group (P<0.05). In the observation group, there were 40 cases of liver fibrosis in stage S0, 26 cases in stage S1, 9 cases in stage S2, 3 cases in stage S3, and 2 cases in stage S4, and the comparisons of PVD, PVVmean, PVQ, SVD, SVVmean, and SVQ among patients with different liver fibrosis grades revealed statistically significant differences (P<0.05). ROC analysis showed that the area under the curve (AUC) of liver CDFI parameters combined with SWE for diagnosing NAFLD was higher than that of single detection, and the AUC of liver CDFI parameters combined with SWE for diagnosing liver fibrosis in NAFLD patients was also higher than that of single detection (P<0.05).

Conclusion

Liver CDFI combined with SWE has a high diagnostic value for both NAFLD and liver fibrosis, and should be closely monitored in clinical practice.

Key words: Non-alcoholic fatty liver disease, Color Doppler flow imaging, Portal vein, Splenic vein, Shear wave elastography, Diagnostic value

表1 两组基线情况比较[例（%）]

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	吸烟[例(%)]	饮酒[例(%)]	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]
组别	例数	男	女	年龄(岁,±s)	体重指数(kg/m²,±s)	吸烟[例(%)]	饮酒[例(%)]	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]
观察组	80	51(63.75)	29(36.25)	51.72±6.61	24.34±3.02	36(45.00)	20(25.00)	33(41.25)	17(21.25)	24(30.00)
对照组	80	54(67.50)	26(32.50)	50.03±7.51	23.95±3.11	28(35.00)	16(20.00)	24(30.00)	18(22.50)	19(23.75)
χ²/t值		0.249		1.511	0.805	1.667	0.574	2.208	0.037	0.795
P值		0.618		0.133	0.422	0.197	0.449	0.137	0.848	0.373

表1 两组基线情况比较[例（%）]

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	吸烟[例(%)]	饮酒[例(%)]	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]
组别	例数	男	女	年龄(岁,±s)	体重指数(kg/m²,±s)	吸烟[例(%)]	饮酒[例(%)]	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]
观察组	80	51(63.75)	29(36.25)	51.72±6.61	24.34±3.02	36(45.00)	20(25.00)	33(41.25)	17(21.25)	24(30.00)
对照组	80	54(67.50)	26(32.50)	50.03±7.51	23.95±3.11	28(35.00)	16(20.00)	24(30.00)	18(22.50)	19(23.75)
χ²/t值		0.249		1.511	0.805	1.667	0.574	2.208	0.037	0.795
P值		0.618		0.133	0.422	0.197	0.449	0.137	0.848	0.373

表2 两组肝脏彩色多普勒血流成像与剪切波弹性成像比较（

±s）

组别	例数	PVD(cm)	PVVmean(cm/s)	PVQ(mL/min)	SVD(cm)	SVVmean(cm/s)	SVQ(mL/min)	杨氏模量(kPa)
观察组	80	1.33±0.30	13.43±2.02	1123.50±222.01	1.04±0.25	18.18±3.01	845.29±140.91	9.63±2.81
对照组	80	1.10±0.20	18.05±2.27	1009.58±121.10	0.75±0.12	23.39±2.81	646.49±98.20	4.62±1.51
t值		5.706	13.599	4.029	9.354	11.317	10.353	14.047
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表2 两组肝脏彩色多普勒血流成像与剪切波弹性成像比较（

±s）

组别	例数	PVD(cm)	PVVmean(cm/s)	PVQ(mL/min)	SVD(cm)	SVVmean(cm/s)	SVQ(mL/min)	杨氏模量(kPa)
观察组	80	1.33±0.30	13.43±2.02	1123.50±222.01	1.04±0.25	18.18±3.01	845.29±140.91	9.63±2.81
对照组	80	1.10±0.20	18.05±2.27	1009.58±121.10	0.75±0.12	23.39±2.81	646.49±98.20	4.62±1.51
t值		5.706	13.599	4.029	9.354	11.317	10.353	14.047
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表3 不同肝纤维化分期患者彩色多普勒血流成像与剪切波弹性成像比较（

±s）

肝纤维化分期	例数	PVD(cm)	PVVmean(cm/s)	PVQ(mL/min)	SVD(cm)	SVVmean(cm/s)	SVQ(mL/min)	杨氏模量(kPa)
S0期	40	1.15±0.21	14.73±1.04	1029.35±131.12	0.88±0.11	20.20±1.86	771.58±102.03	7.92±0.92
S1期	26	1.37±0.20^a	12.96±1.66^a	1116.19±82.83^a	1.10±0.16^a	17.31±1.52^a	867.62±89.74^a	9.80±1.00^a
S2期	9	1.59±0.16^ab	11.11±1.17^ab	1314.78±217.02^ab	1.26±0.10^ab	15.56±1.81^ab	941.33±74.72^ab	12.01±1.38^ab
S3期	3	1.90±0.10^abc	10.33±0.58^abc	1526.67±58.29^abc	1.53±0.15^abc	12.33±0.58^abc	1103.33±26.27^abc	15.00±1.61^abc
S4期	2	2.25±0.21^abcd	8.50±0.71^abcd	1616.00±24.04^abcd	1.85±0.21^abcd	9.50±0.71^abcd	1210.00±32.58^abcd	22.70±0.56^abcd
F值		27.722	30.270	40.798	54.341	42.592	32.689	128.616
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表3 不同肝纤维化分期患者彩色多普勒血流成像与剪切波弹性成像比较（

±s）

肝纤维化分期	例数	PVD(cm)	PVVmean(cm/s)	PVQ(mL/min)	SVD(cm)	SVVmean(cm/s)	SVQ(mL/min)	杨氏模量(kPa)
S0期	40	1.15±0.21	14.73±1.04	1029.35±131.12	0.88±0.11	20.20±1.86	771.58±102.03	7.92±0.92
S1期	26	1.37±0.20^a	12.96±1.66^a	1116.19±82.83^a	1.10±0.16^a	17.31±1.52^a	867.62±89.74^a	9.80±1.00^a
S2期	9	1.59±0.16^ab	11.11±1.17^ab	1314.78±217.02^ab	1.26±0.10^ab	15.56±1.81^ab	941.33±74.72^ab	12.01±1.38^ab
S3期	3	1.90±0.10^abc	10.33±0.58^abc	1526.67±58.29^abc	1.53±0.15^abc	12.33±0.58^abc	1103.33±26.27^abc	15.00±1.61^abc
S4期	2	2.25±0.21^abcd	8.50±0.71^abcd	1616.00±24.04^abcd	1.85±0.21^abcd	9.50±0.71^abcd	1210.00±32.58^abcd	22.70±0.56^abcd
F值		27.722	30.270	40.798	54.341	42.592	32.689	128.616
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

图1　彩色多普勒血流成像与剪切波弹性成像诊断非酒精性脂肪性肝病的ROC曲线　图2　彩色多普勒血流成像与剪切波弹性成像诊断非酒精性脂肪性肝病患者肝纤维化的ROC曲线注：PVD门静脉主干内径、PVVmean门静脉平均血流速度、PVQ门静脉血流量、SVD脾静脉内径、SVVmean脾静脉平均血流速度、SVQ脾静脉血流量

表4 彩色多普勒血流成像与剪切波弹性成像对非酒精性脂肪性肝病的诊断价值

指标	AUC	标准误	P值	95% CI	敏感度(%)	特异度(%)	截断值
PVD	0.721	0.040	<0.001	0.643~0.800	53.80	82.50	1.20 cm
PVVmean	0.939	0.019	<0.001	0.902~0.975	87.50	88.80	15.50 cm/s
PVQ	0.693	0.042	<0.001	0.612~0.775	48.80	87.50	1084 mL/min
SVD	0.876	0.026	<0.001	0.825~0.928	77.50	81.20	0.85 cm
SVVmean	0.902	0.023	<0.001	0.857~0.947	79.70	85.00	20.50 cm/s
SVQ	0.879	0.027	<0.001	0.827~0.931	77.50	83.80	735.50 mL/min
杨氏模量	0.892	0.024	<0.001	0.846~0.939	78.80	81.20	7.55 kPa
联合检测	0.992	0.006	<0.001	0.980~0.999	97.50	98.80	-

表4 彩色多普勒血流成像与剪切波弹性成像对非酒精性脂肪性肝病的诊断价值

指标	AUC	标准误	P值	95% CI	敏感度(%)	特异度(%)	截断值
PVD	0.721	0.040	<0.001	0.643~0.800	53.80	82.50	1.20 cm
PVVmean	0.939	0.019	<0.001	0.902~0.975	87.50	88.80	15.50 cm/s
PVQ	0.693	0.042	<0.001	0.612~0.775	48.80	87.50	1084 mL/min
SVD	0.876	0.026	<0.001	0.825~0.928	77.50	81.20	0.85 cm
SVVmean	0.902	0.023	<0.001	0.857~0.947	79.70	85.00	20.50 cm/s
SVQ	0.879	0.027	<0.001	0.827~0.931	77.50	83.80	735.50 mL/min
杨氏模量	0.892	0.024	<0.001	0.846~0.939	78.80	81.20	7.55 kPa
联合检测	0.992	0.006	<0.001	0.980~0.999	97.50	98.80	-

表5 彩色多普勒血流成像与剪切波弹性成像对非酒精性脂肪性肝病患者肝纤维化的诊断价值

指标	AUC	标准误	P值	95% CI	敏感度(%)	特异度(%)	截断值
PVD	0.772	0.051	<0.001	0.672~0.872	77.50	42.50	1.27 cm
PVVmean	0.866	0.044	<0.001	0.780~0.953	77.50	87.50	13.50 cm/s
PVQ	0.780	0.052	<0.001	0.678~0.882	87.50	45.00	1103 mL/min
SVD	0.914	0.031	<0.001	0.853~0.975	75.00	89.10	1.05 cm
SVVmean	0.906	0.032	<0.001	0.844~0.968	80.00	85.00	18.50 cm/s
SVQ	0.764	0.053	<0.001	0.660~0.867	77.50	72.30	802 mL/min
杨氏模量	0.797	0.052	<0.001	0.696~0.899	72.50	82.50	8.80 kPa
联合检测	0.991	0.008	<0.001	0.975~0.998	97.50	95.00	-

表5 彩色多普勒血流成像与剪切波弹性成像对非酒精性脂肪性肝病患者肝纤维化的诊断价值

指标	AUC	标准误	P值	95% CI	敏感度(%)	特异度(%)	截断值
PVD	0.772	0.051	<0.001	0.672~0.872	77.50	42.50	1.27 cm
PVVmean	0.866	0.044	<0.001	0.780~0.953	77.50	87.50	13.50 cm/s
PVQ	0.780	0.052	<0.001	0.678~0.882	87.50	45.00	1103 mL/min
SVD	0.914	0.031	<0.001	0.853~0.975	75.00	89.10	1.05 cm
SVVmean	0.906	0.032	<0.001	0.844~0.968	80.00	85.00	18.50 cm/s
SVQ	0.764	0.053	<0.001	0.660~0.867	77.50	72.30	802 mL/min
杨氏模量	0.797	0.052	<0.001	0.696~0.899	72.50	82.50	8.80 kPa
联合检测	0.991	0.008	<0.001	0.975~0.998	97.50	95.00	-

[1]	吴车敏, 张从玉, 徐慧丽, 等. 我国非酒精性脂肪性肝病的流行病学研究和诊断现状分析[J]. 中国医药导报, 2023, 20(11): 158-161.
[2]	Grander C, Grabherr F, Tilg H. Non-alcoholic fatty liver disease: pathophysiological concepts and treatment options[J]. Cardiovasc Res, 2023, 119(9): 1787-1798.
[3]	Lee KC, Wu PS, Lin HC. Pathogenesis and treatment of non- alcoholic steatohepatitis and its fibrosis[J]. Clin Mol Hepatol, 2023, 29(1): 77-98.
[4]	Basheer M, Naffaa M, Assy N. Non-invasive biomarkers of liver fibrosis in non-alcoholic fatty liver disease[J]. Clin Mol Hepatol, 2023, 29(2): 398-400.
[5]	Schambeck JPL, Forte GC, Gonçalves LM, et al. Diagnostic accuracy of magnetic resonance elastography and point-shear wave elastography for significant hepatic fibrosis screening: Systematic review and meta-analysis[J]. PLoS One, 2023, 18(2): e0271572.
[6]	中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 947-957.
[7]	中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 肝纤维化诊断及治疗共识(2019年)[J]. 中华肝脏病杂志, 2019, 27(9): 657-667.
[8]	Lee KC, Wu PS, Lin HC. Pathogenesis and treatment of non- alcoholic steatohepatitis and its fibrosis[J]. Clin Mol Hepatol, 2023, 29(1): 77-98.
[9]	沈颖筱, 施惠海, 罗家乐, 等. 非酒精性脂肪性肝病肝纤维化风险预测模型的应用与进展[J]. 实用临床医药杂志, 2023, 27(9): 131-136, 142.
[10]	Mózes FE, Lee JA, Vali Y, et al. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis[J]. Lancet Gastroenterol Hepatol, 2023, 8(8): 704-713.
[11]	Bauer DJ, Matic V, Mare R, et al. Point Shear Wave Elastography by ElastPQ for Fibrosis Screening in Patients with NAFLD: A Prospective, Multicenter Comparison to Vibration-Controlled Elastography[J]. Ultraschall Med, 2023, 44(2): 169-178.
[12]	Ogino Y, Wakui N, Nagai H, et al. Comparison of strain elastography and shear wave elastography in diagnosis of fibrosis in nonalcoholic fatty liver disease[J]. J Med Ultrason, 2023, 50(2): 187-195.
[13]	Yamaguchi K, Seko Y, Sakai T, et al. Comparison of portal vein hemodynamics with ultrasound-based elastography for the prediction of liver fibrosis in patients with chronic liver disease[J]. Sci Rep, 2023, 13(1): 3425.
[14]	段欣, 苏鹏娟, 张改, 等. 腹部超声联合血清LncRNA H19、LncRNA PVT1水平检测对慢性乙型肝炎肝纤维化程度的诊断价值[J]. 中西医结合肝病杂志, 2025, 35(9): 1109-1113.
[15]	曾晓蓉, 李丹, 牟荥, 等. 基于彩色多普勒超声在定量评估乙型肝炎肝纤维化患者脾静脉内径和门静脉内径中的价值[J]. 影像科学与光化学, 2023, 41(5): 238-246.
[16]	Hamasaki M, Araki T, Tamada D, et al. Four-dimensional flow magnetic resonance imaging for assessment of hemodynamic changes in the portal venous system before and after balloon- occluded retrograde transvenous obliteration: a pilot feasibility study[J]. Acta Radiol, 2023, 4(4): 462-1468.
[17]	商宁, 黄秀香, 田楠楠, 等. 原发性胆汁性胆管炎的肝脏硬度值与脾静动脉血流学参数的相关性分析[J]. 生物医学工程与临床, 2023, 27(3): 286-291.
[18]	李玲子, 杨倩, 马晓鸣. 点剪切波弹性成像与瞬时弹性成像评估非酒精性脂肪肝患者肝纤维化分期的Meta分析[J]. 临床超声医学杂志, 2024, 26(10): 868-876.
[19]	Schambeck JPL, Forte GC, Gonçalves LM, et al. Diagnostic accuracy of magnetic resonance elastography and point-shear wave elastography for significant hepatic fibrosis screening: Systematic review and meta-analysis[J]. PLoS One, 2023, 18(2): e0271572.
[20]	赵丽敏, 郭卫红, 苏秀丽. 肝脏彩色多普勒超声血流参数及剪切波弹性成像在非酒精性脂肪性肝病患者诊断中的价值[J]. 实用医院临床杂志, 2025, 22(5): 171-175.

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Value of combined application of color Doppler flow imaging and shear wave elastography in the diagnosis and fibrosis staging of non-alcoholic fatty liver disease

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Value of combined application of color Doppler flow imaging and shear wave elastography in the diagnosis and fibrosis staging of non-alcoholic fatty liver disease