定量CT脂肪参数诊断代谢综合征的最佳临界值及效能评价  

Optimal cut-off value and performance of adipose parameters of quantitative CT in the diagnosis of metabolic syndrome

作　　者：张宇阳 吕英茹 蒋琳[2] 王兵[2] 谢玉雪 陈爽 ZHANG Yu-yang;LV Ying-ru;JIANG Lin(Department of Radiology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院放射科,上海200040 [2]复旦大学附属华山医院体检中心,上海200040

出　　处：《放射学实践》2022年第12期1468-1473,共6页Radiologic Practice

基　　金：国家自然科学基金面上基金(82171911);国家自然科学青年基金(82102013);国家重点研发计划资助项目(2018YFC2000205)。

摘　　要：目的:探讨定量CT(QCT)肝脏和腹腔内脂肪参数诊断代谢综合征(MS)的最佳临界值及效能。方法:回顾性分析2019年6月-12月本院1151例体检人群的临床和CT资料。男性中代谢综合征的患病率为18.9%(111/587),女性为26.1%(147/564)。使用专用软件,测量肝脏的定量脂肪参数,包括肝脏和脾脏的平扫CT值以及肝脏CT脂肪分数(CTFF);并在L_(2-3)椎间盘层面测量腹腔内脂肪组织(VAT)、皮下脂肪组织(SAT)、总脂肪组织(TAT)和非脂肪组织(NAT)的面积,计算脾脏与肝脏CT值的差值(ΔCT_(脾-肝))和比值(CTR_(脾/肝))。采用受试者工作特征(ROC)曲线分析肝脏CTFF、肝脏CT值、脾脏CT值、ΔCT_(脾-肝)、CTR_(脾/肝)、VAT/TAT、TAT/NAT、VAT/NAT和SAT/NAT等指标诊断MS的效能。结果:在男性组中,ΔCT_(脾-肝)和CTR_(脾/肝)诊断MS的AUC(0.736、0.738)均高于肝脏CTFF(0.693),差异均有统计学意义(P均<0.05);而肝脏CT值诊断MS的AUC与肝脏CTFF比较,差异无统计学意义(P=0.500);TAT和VAT诊断MS的效能(AUC=0.823、0.818)优于其它腹部脂肪测量指标(P均<0.05)。在女性组中,肝脏CTFF、肝脏CT值和ΔCT_(脾-肝)诊断MS的效能均不高(AUC=0.609~0.626),且差异无统计学意义(P>0.05);TAT和SAT诊断MS的效能(AUC=0.830、0.810)优于其它腹部脂肪测量指标(P均<0.05)。结论:QCT测量的TAT、VAT和SAT对于诊断MS具有重要价值,肝脏脂肪定量指标诊断MS价值有限。Objective:To investigate the optimal cut-off value and performance of liver and visceral adipose parameters of quantitative CT(QCT)in the diagnosis of metabolic syndrome(MS).Methods:A total of 1151 individuals from the medical examination center from Fudan University Huashan hospital during June to December in 2019 were retrospectively analyzed.Using the dedicated Mindways software,the liver fat parameters including non-contrast enhanced CT values of liver and spleen,and liver CT fat fraction(CTFF)were measured;and at L_(2-3) level,the areas of visceral adipose tissue(VAT),subcutaneous adipose tissue(SAT),total adipose tissue(TAT)and non-adipose tissue(NAT)were measured.The difference(ΔCT_(S-L))and ratio(CTR_(S/L))of spleen-liver attenuation were manually calculated.Receiver operating characteristic(ROC)curve was used to identify the area under curve(AUC),sensitivity,and specificity of liver CTFF,non-contrast enhanced CT values of liver and spleen,DCT_(S-L),CTR_(S/L),VAT/TAT,TAT/NAT,VAT/NAT and SAT/NAT.Results:The prevalence of MS was 18.9%(111/587)among men and 26.1%(147/564)among women.In the male group,the AUCs ofΔCT_(S-L)(0.736)and CTR_(S/L)(0.738)were higher than that of CTFF(0.693)with statistical difference(both P<0.05).There was no statistical significance between AUC of CTFF and CT atte-nuation of liver(P=0.500).The efficacy of TAT and VAT(AUC=0.823,0.818)for the diagnosis of MS was superior to that of the other abdominal fat parameters(both P<0.05).In the female group,the diagnostic performance of CTFF,CT attenuation of liver,andΔCT_(S-L) were relatively poor(AUC=0.609~0.626),which showed no statistical significance(P>0.05).The efficacy of TAT and SAT(AUC=0.830,0.810)for the diagnosis of MS was superior to that of the other abdominal fat parameters(both P<0.05).Conclusion:TAT,VAT,and SAT of QCT play roles in the diagnosis of MS,while quantitative liver fat indicators are of limited value in the diagnosis of MS.

关 键 词：定量CT 代谢综合征 脂肪分数 诊断效能 

分 类 号：R814.42[医药卫生—影像医学与核医学] R589.1[医药卫生—放射医学] R589.2[医药卫生—临床医学]