利用人体成分分析构建脂肪肝诊断模型  

Construction of a diagnostic model for fatty liver using human body composition analysis

作　　者：张颖 蒯文涛 张勇湛[1] 宋元申 贺登花 裴佳佳 徐亮[1,2] Zhang Ying;Kuai Wentao;Zhang Yongzhan;Song Yuanshen;He Denghua;Pei Jiajia;Xu Liang(Tianjin Second People's Hospital,Tianjin 300192,China;Tian jin Research Institute of Liver Disease,Tian jin 300192,China;Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津市第二人民医院,天津300192 [2]天津市肝病医学研究所,天津300192 [3]天津市第三中心医院,天津300170

出　　处：《中华肝脏病杂志》2023年第12期1277-1282,共6页Chinese Journal of Hepatology

基　　金：天津市卫生健康科技项目重点学科专项(TJWJ2022XK034);天津市医学重点学科(专科)建设项目资助(TJYXZDXK-059B);天津市卫生健康委员会中西医结合科研课题重点项目(2021022)。

摘　　要：目的利用人体成分分析构建脂肪肝诊断模型,并评估该模型对脂肪肝的诊断效果。方法回顾性纳入2019年4月至2022年6月在天津市第二人民医院就诊并行人体成分分析检查的慢性肝病患者726例,根据腹部超声和受控衰减参数测定值将其分为脂肪肝组(有脂肪肝,551例)和对照组(无脂肪肝,175例)。统计学处理采用独立样本t检验和非参数秩和检验;利用logistic回归构建诊断模型,并用Hosmer-Lemeshow对模型拟合度进行验证,采用受试者操作特征曲线验证模型诊断效能。另外纳入2022年7月至2023年2月在天津市第二人民医院就诊的341例慢性肝病患者对模型做进一步应用效果验证。结果脂肪肝组与对照组相比,人体成分分析检查的各项指标差异均有统计学意义(P<0.05)。最终将基础代谢率(X1)、内脏脂肪面积(X2)、体脂肪(X3)纳入诊断模型:BCA-FL(body composition analysis-fatty liver)=-7.771+0.002^(*)X1-0.035X2+0.456X3,Hosmer-Lemeshow检验P值为0.059。以受试者操作特征曲线的约登指数0.615作为诊断的临界值,测得受试者操作特征曲线下面积为0.888,敏感度为0.889,特异度为0.726。模型验证组的受试者操作特征曲线下面积为0.875,约登指数为0.624,灵敏度为0.799,特异度为0.825。结论利用人体成分分析构建的脂肪肝的诊断模型BCA-FL,诊断效能佳,适用于不同肝病基础人群的脂肪肝筛查。Objective To construct a diagnostic model for fatty liver using body composition analysis and further evaluate the diagnostic effect of the model on fatty liver.Methods 726 cases with chronic liver disease who visited Tianjin Second People's Hospital from April 2019 to June 2022 and had body composition analysis tests were retrospectively enrolled and were divided into a fatty liver group(551 cases with fatty liver)and a control group(175 cases without fatty liver)according to the measured values of abdominal ultrasound and controlled attenuation parameter.An independent sample t-test and a non-parametric rank sum test were used for statistical processing.Logistic regression was used to construct a diagnostic model.Hosmer-Lemeshow was used to validate the fit of model.Receiver operating characteristic curve was used to confirm the diagnostic efficiency of the model.In addition,341 cases of chronic liver disease who visited Tianjin Second People's Hospital were included to further verify the application effect of the model between July 2022 and February 2023.Results Compared with the control group,the differences in various indicators of body composition analysis in the fatty liver group were statistically significant(P<0.05).Basal metabolic rate(X1),visceral fat area(X2),and body fat(X3)were eventually included in the diagnostic model for BCA-FL(body composition analysis-fatty liver)=-7.771+0.002X1-0.035X2+0.456X3 with the Hosmer-Lemeshow test(P=0.059).The measured area under the receiver operating characteristic curve,the sensitivity,and the specificity were 0.888,0.889,and 0.726,respectively,when the diagnostic threshold value was 0.615 with the Youden index and the receiver operating characteristic curve.In the validated model group,the area under the receiver operating characteristic curve,Youden index,sensitivity,and specificity were 0.875,0.624,0.799,and 0.825,respectively.Conclusion The diagnostic model BCA-FL for fatty liver constructed using human body composition analysis has good diagnostic efficacy an

关 键 词：脂肪肝 人体成分分析 诊断模型 

分 类 号：R575.5[医药卫生—消化系统]