肝脏受控衰减参数与人体脂肪质量和其分布的关系  

Relationship between liver controlled attenuation parameters and body fat mass and its distribution

作　　者：邵幼林[1] 张锁才[1] 吴剑明[1] 郭风彩[1] 柳龙根[1] 叶春艳[1] 严桐[1] 曹琪[1] 张凡[2] 王静[3] 毛永华 范建高[5] Shao Youlin;Zhang Suocai;Wu Jianming;Guo Fengcai;Liu Longgen;Ye Chunyan;Yan Tong;Cao Qi;Zhang Fan;Wang Jing;Mao Yonghua;Fan Jiangao(Department of Hepatology and Center of Fatty Liver, Changzhou Third People's Hospital, Changzhou 213001, China;Department of Endocrinology and Center of Fatty Liver, Changzhou Third People's Hospital, Changzhou 213001, China;Department of Cardiology and Center of Fatty Liver, Changzhou Third People's Hospital, Changzhou 213001, China;Department of Nutrition and Center of Fatty Liver, Changzhou Third People's Hospital, Changzhou 213001, China;Department of Gastroenterology and Center of Fatty Liver, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China)

机构地区：[1]江苏省常州市第三人民医院肝病科暨脂肪肝中心,213001 [2]江苏省常州市第三人民医院内分泌科暨脂肪肝中心,213001 [3]江苏省常州市第三人民医院心内科暨脂肪肝中心,213001 [4]江苏省常州市第三人民医院营养科暨脂肪肝中心,213001 [5]上海交通大学医学院附属新华医院消化内科暨脂肪肝中心,200092

出　　处：《中华肝脏病杂志》2019年第10期754-759,共6页Chinese Journal of Hepatology

基　　金：国家科技部精准医学研究项目(2017YFC0908903);国家自然科学基金(81470840、81873565).

摘　　要：目的探讨肝脏受控衰减参数(CAP)与人体脂肪质量和其分布的关系。方法2018年5月至12月在常州市第三人民医院脂肪肝中心就诊的成年患者978例,通过瞬时弹性成像技术测量患者肝脏CAP,生物电阻抗技术测量人体脂肪质量和其分布。采用Pearson相关系数描述肝脏CAP值与体质量指数(BMI)、体脂肪质量指数(BFMI)、躯干脂肪质量指数(TFMI)、四肢脂肪质量指数(LFMI)和内脏脂肪面积(VFA)等的相关性,通过受试者工作特征曲线(ROC)及曲线下面积(AUC)评价BMI、BFMI、TFMI、LFMI和VFA等区分CAP诊断S0~1和S2~3级脂肪变的截点和效能。结果男性653例,S0~S3分别占4.90%、3.37%、22.36%和69.37%;女性325例,S0~S3分别占7.38%、6.46%、13.23%和72.92%,女性内脏、躯干和四肢脂肪均多于男性(P值均< 0.01)。男性与女性患者体质量、体脂肪质量、体脂率、BMI、BFMI、TFMI、LFMI、VFA均随着肝脂肪变等级增加而升高(P值< 0.01)。男性、女性患者肝脏CAP值与BMI、BFMI、TFMI、LFMI和VFA均呈正相关。躯干脂肪质量百分比随肝脏脂肪变等级增加而增加(男性:F = 13.42,P < 0.001;女性:F = 3.22,P = 0.023);而四肢脂肪质量百分比并未随肝脏脂肪变等级增加而增加(男性:F = 1.13,P = 0.34;女性:F = 1.05,P = 0.37)。CAP诊断的S0~1或S2~3肝脂肪变性可通过BMI、BFMI、TFMI、LFMI和VFA来区分,AUC在男性中为0.80~0.82(P值均<0.01),在女性中为0.75~0.78(P值均<0.01)。结论肝脏CAP值与人体四肢、躯干、内脏脂肪量呈正相关,与躯干和内脏脂肪量相关性更强;BMI、BFMI、TFMI、LFMI和VFA在一定程度上可以鉴别出CAP诊断的S0~1和S2~3级肝脏脂肪变。Objective To explore the relationship between liver controlled attenuation parameters (CAP) and body fat mass and its distribution. Methods From May to December 2018, 978 adult patients visited at the fatty liver center of the Third People's Hospital of Changzhou were treated. The patient's liver controlled attenuation parameters were measured by transient elastography and the body fat mass and its distribution were measured by bioelectrical impedance technology. Pearson’s correlation coefficient was adopted to describe the correlation between liver CAP value and body mass index (BMI), body fat mass index (BFMI), trunk fat mass index (TFMI), limbs fat mass index (LFMI) and visceral fat area (VFA). Receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate BMI, BFMI, TFMI, LFMI and VFA to differentiate the cut-off points and efficacy of CAP for diagnosing grading of fatty liver changes in S0-1 and S2-3. Results In 653 cases of male, S0 ~ S3 accounted for 4.90%, 3.37%, 22.36% and 69.37%, respectively, and in 325 cases of females, S0 ~ S3 accounted for 7.38%, 6.46%, 13.23% and 72.92%, respectively. Female patients had more visceral, trunk and limbs fat than male (P < 0.01). Body mass, body fat mass, body fat percentage, BMI, BFMI, TFMI, LFMI, and VFA were increased in male and female patients with increasing liver fat grade (P < 0.01). CAP values ??of male and female patients were positively correlated with BMI, BFMI, TFMI, LFMI and VFA. Percentage of body fat mass increased with increasing liver fat grade (male: F = 13.42, P < 0.001;female: F = 3.22, P = 0.023);while limb fat mass percentage did not increase with liver fat grade (Male: F = 1.13, P = 0.34;female: F = 1.05, P = 0.37). Hepatic steatosis grading (S0 ~ 1 or S2 ~ 3) diagnosed with CAP were distinguished through BMI, BFMI, TFMI, LFMI and VFA. AUC was 0.80 ~ 0.82 in males (P < 0.01), and 0.75 ~ 0.78 in females (P < 0.01). Conclusion The liver CAP value is positively correlated with the body's limbs, trunk and visce

关 键 词：脂肪肝 受控衰减参数 体脂肪质量 

分 类 号：R575[医药卫生—消化系统]