超声声衰减成像定量参数联合RC/HDL-C诊断MAFLD肝脂肪变程度的效能及与脂代谢的相关性

摘要/Abstract

摘要： 目的探讨超声声衰减成像定量参数联合残余胆固醇/高密度脂蛋白胆固醇(residual cholesterol/high-density lipoprotein cholesterol,RC/HDL-C)诊断代谢相关脂肪性肝病(MAFLD)肝脂肪变程度的效能及与脂代谢的相关性。方法回顾性分析2021年1月至2023年12月于邯郸市人民医院接受检查的146例MAFLD患者的临床资料,根据MAFLD肝脂肪变程度分为轻度组、中度组、重度组,比较各组间声衰减系数(attenuation coefficient,AC)、RC/HDL-C水平,分析AC与RC/HDL-C的相关性,以及MAFLD肝脂肪变程度的影响因素,评估AC、RC/HDL-C对MAFLD肝脂肪变程度的诊断效能。结果 146例MAFLD患者中,肝脂肪变轻度36例(24.66%)、中度58例(39.73%)、重度52例(35.62%)。轻度组、中度组、重度组患者的AC分别为(0.71±0.22)、(0.80±0.25)、(0.93±0.28)dB/(cm·MHz),RC/HDL-C分别为(0.18±0.04)、(0.22±0.05)、(0.23±0.07),差异有统计学意义(P<0.05)。AC(OR=3.677,95%CI:1.085～12.453)、RC/HDL-C(OR=4.133,95%CI:1.221～13.998)是MAFLD患者中重度肝脂肪变程度的危险因素(P<0.05)。AC、RC/HDL-C单一及联合诊断中重度肝脂肪变程度的灵敏度分别为0.61、0.68、0.77,特异度分别为0.87、0.79、0.87,曲线下面积分别为0.736、0.738、0.829。结论 AC、RC/HDL-C可用于MAFLD肝脂肪变程度的辅助诊断,且诊断效能良好。

Abstract: Objective To evaluate the diagnostic accuracy of quantitative ultrasound attenuation imaging parameters combined with the Residual Cholesterol/High-Density Lipoprotein Cholesterol (RC/HDL-C) ratio, in detecting hepatic steotosis in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Additionally, to investigate the correlation between these parameters and lipid metabolism in the context of liver fat infiltration. Methods A retrospective analysis was performed on the medical records of 146 patients with MAFLD who were examined at the People's Hospital of Handan City from January 2021 to December 2023 in . Based on the degree of hepatic steatosis, patients were categorized into mild, moderate, and severe groups. Differences in attenuation coefficient (AC), and RC/HDL-C levels among these groups were compared. The correlation between AC and RC/HDL-C was analyzed, and factors influencing liver fat infiltration in MAFLD were evaluated. Additionally, the diagnostic efficacy of AC and RC/HDL-C in assessing the severity of hepatic steatosis in MAFLD was examined. Results Among the 146 patients with MAFLD, 36 cases (24.66%) had mild hepatic steatosis, 58 cases (39.73%) had moderate steatosis, and 52 cases (35.62%) had severe steatosis. The AC for the mild, moderate, and severe groups were (0.71±0.22) dB cm^-1 MHz^-1, (0.80±0.25) dB cm^-1 MHz^-1, and (0.93±0.28) dB cm^-1 MHz^-1, respectively. The RC/HDL-C ratios were (0.18±0.04), (0.22±0.05), and (0.23±0.07), respectively. The differences were statistically significant (P<0.05). Both AC (OR=3.677, 95% CI: 1.085-12.453) and RC/HDL-C (OR=4.133, 95% CI: 1.221-13.998) were identidied as risk factors for the severity of hepatic steatosis in MAFLD patients (P<0.05). The sensitivity and specificity for diagnosing moderate to severe liver steatosis using AC, RC/HDL-C, and their combination were 0.61, 0.68, and 0.77, respectively, with corresponding area under the curve(AUC) values of 0.736, 0.738, and 0.829. Conclusion AC, RC/HDL-C can serve as auxiliary diagnostic tools for assessing the degree of hepatic steatosis in MAFLD, demonstrating good diagnostic efficacy.

Key words: Metabolic related fatty liver disease, The degree of hepatic steatosis, Ultrasound attenuation imaging, Ultrasonic attenuation coefficient, Residual cholesterol/high-density lipoprotein cholesterol, Diagnostic efficacy

胡丽军, 连倩倩. 超声声衰减成像定量参数联合RC/HDL-C诊断MAFLD肝脂肪变程度的效能及与脂代谢的相关性[J]. 肝脏, 2024, 29(10): 1260-1264.

HU Li-jun, LIAN Qian-qian. Diagnostic value of ultrasound attenuation imaging parameters combined with residual cholesterol/HDL-C in assessing hepatic steatosis of MAFLD and its correlation with lipid metabolism[J]. Chinese Hepatolgy, 2024, 29(10): 1260-1264.

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参考文献

[1] Eslam M, Sanyal A J, George J. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease[J]. Gastroenterology,2020,158(7):1999-2014.
[2] Kawaguchi T, Tsutsumi T, Nakano D, et al. MAFLD: renovation of clinical practice and disease awareness of fatty liver[J]. Hepatol Res,2022,52(5):422-432.
[3] Mantovani A, Lombardi R, Cattazzo F, et al. MAFLD and CKD: an updated narrative review[J]. Int J Mol Sci,2022,23(13):7007.
[4] 林颖鑫,孟健,冯蕾,等. 声衰减成像在代谢相关脂肪性肝病分级诊断中的应用[J]. 中国医学影像学杂志,2023,31(10):1080-1084,1102.
[5] 刘婷婷,林妍冰,汪珊,等. 超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值[J]. 中华医学超声杂志(电子版),2023,20(8):787-794.
[6] 武云霞,黄灵娟,罗钊晓,等. 残余胆固醇/高密度脂蛋白胆固醇比值与代谢相关脂肪性肝病相关性的研究[J]. 国际消化病杂志,2023,43(5):310-316.
[7] Hirano T, Satoh N, Ito Y. Specific increase in small dense low-density lipoprotein-cholesterol levels beyond Triglycerides in patients with diabetes: implications for cardiovascular risk of MAFLD[J]. J Atheroscler Thromb,2024,31(1):36-47.
[8] 包静文,朱宇莉,徐庆玥,等. 超声声衰减成像评估代谢相关脂肪性肝病肝脂肪变程度的应用价值[J]. 中华超声影像学杂志,2021,30(10):868-873.
[9] Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement[J]. J Hepatol,2020,73(1):202-209.
[10] 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.
[11] Lim G, Tang A, Ng C H, et al. An observational data meta-analysis on the differences in prevalence and risk factors between MAFLD vs NAFLD[J]. Clin Gastroenterol Hepatol,2023,21(3):619-629.
[12] Sangro P, de la Torre A M, Sangro B, et al. Metabolic dysfunction-associated fatty liver disease (MAFLD): an update of the recent advances in pharmacological treatment[J]. J Physiol Biochem,2023,79(4):869-879.
[13] Vitale A, Svegliati-Baroni G, Ortolani A, et al. Epidemiological trends and trajectories of MAFLD-associated hepatocellular carcinoma 2002-2033: the ITA.LI.CA database[J]. Gut,2023,72(1):141-152.
[14] Crane H, Gofton C, Sharma A, et al. MAFLD: an optimal framework for understanding liver cancer phenotypes[J]. J Gastroenterol,2023,58(10):947-964.
[15] Kaya E, Yilmaz Y. Metabolic-associated fatty liver disease: a multi-systemic disease beyond the liver[J]. J Clin Transl Hepatol,2022,10(2):329-338.
[16] Liang Y, Chen H, Liu Y, et al. Association of MAFLD with diabetes, chronic kidney disease, and cardiovascular disease: a 4.6-year cohort study in China[J]. J Clin Endocrinol Metab,2022,107(1):88-97.
[17] 张德清,王东东,胡云方,等. 短TE校正同相位、小角度激发双回波成像评价非酒精性脂肪性肝病脂肪浸润程度[J]. 实用放射学杂志,2022,38(8):1284-1288.
[18] 宋华丹,刘明,刘欢欢,等. 超重/肥胖儿童非酒精性脂肪性肝病的磁共振成像质子密度脂肪分数分布特点[J]. 肿瘤影像学,2023,32(4):339-346.
[19] 陈智恒,高博文,桂蓓,等. 代谢相关脂肪性肝病发生脂肪性肝炎的无创诊断模型构建及分析[J]. 临床肝胆病杂志,2023,39(8):1857-1866.
[20] Badmus OO, Hinds TJ, Stec DE. Mechanisms linking metabolic-associated fatty liver disease (MAFLD) to cardiovascular disease[J]. Curr Hypertens Rep,2023,25(8):151-162.
[21] Zhao Q, Deng Y. Comparison of mortality outcomes in individuals with MASLD and/or MAFLD[J]. J Hepatol,2024,80(2):e62-e64.
[22] Filipovic B, Marjanovic-Haljilji M, Mijac D, et al. Molecular aspects of MAFLD-new insights on pathogenesis and treatment[J]. Curr Issues Mol Biol,2023,45(11):9132-9148.
[23] Wang X, Xie Q. Metabolic dysfunction-associated fatty liver disease (MAFLD) and viral hepatitis[J]. J Clin Transl Hepatol,2022,10(1):128-133.
[24] 候萌萌,苑喜微,王一奇,等. 超声衰减参数在代谢相关脂肪性肝病诊断中的应用研究[J]. 中华肝脏病杂志,2022,30(3):290-296.
[25] 王丹,龙富立,连溯,等. 超声声衰减成像对代谢相关性脂肪肝的临床诊断价值及影响因素分析[J]. 临床超声医学杂志,2023,25(1):8-12.
[26] Liu Z, He H, Dai Y, et al. Comparison of the diagnostic value between triglyceride-glucose index and triglyceride to high-density lipoprotein cholesterol ratio in metabolic-associated fatty liver disease patients: a retrospective cross-sectional study[J]. Lipids Health Dis,2022,21(1):55.
[27] Garicano V E, Sanz R S, Lopez O S, et al. Effect of MetioNac(R) in patients with metabolic syndrome who are at risk of metabolic dysfunction associated fatty liver disease: a randomized controlled trial[J]. Nutr Hosp,2023,40(4):755-762.
[28] Moriyama K, Inoue N, Imai J, et al. Prediction and validation of metabolic dysfunction-associated fatty liver disease using insulin resistance-related indices in the Japanese population[J]. Metab Syndr Relat Disord,2023,21(9):489-496.
[29] Farrell A M, Magliano D J, Shaw J E, et al. A problem of proportions: estimates of metabolic associated fatty liver disease and liver fibrosis in Australian adults in the nationwide 2012 AusDiab Study[J]. Sci Rep,2022,12(1):1956.
[30] Binet Q, Loumaye A, Hermans M P, et al. A cross-sectional real-life study of the prevalence, severity, and determinants of metabolic dysfunction-associated fatty liver disease in type 2 diabetes patients[J]. J Clin Transl Hepatol,2023,11(6):1377-1386.