超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值

Evaluation of metabolic dysfunction-associated fatty liver disease in children by ultrasound-guided attenuation parameter

目的探讨超声衰减参数成像(UGAP)评价儿童代谢相关脂肪性肝病(MAFLD)病变程度的价值。方法回顾性选取2022年5月至2023年2月在深圳市儿童医院就诊的肥胖症患儿131例,包括MAFLD组76例、单纯肥胖组55例,同期选取性别、年龄匹配的健康体检儿童58例为正常对照组。比较各组间及不同程度脂肪肝患儿衰减系数(AC)的差异,应用相关比率Eta^(2)和Spearman相关分析法探讨AC值与脂肪肝程度、体质量指数(BMI)、纤维化指数(FIB-4指数)及实验室指标的相关性,通过多因素Logistic回归分析构建MAFLD预测模型并进行诊断效能分析。结果MAFLD组、单纯肥胖组和正常对照组AC值分别为(0.758±0.076)、(0.637±0.039)、0.575(0.560,0.590)dB/cm/MHz,组间差异有统计学意义(P均<0.05)。轻度、中度及重度脂肪肝患儿的AC值分别为(0.728±0.067)、(0.789±0.070)、(0.858±0.041)dB/cm/MHz,组间差异有统计学意义(P均<0.05)。AC值与脂肪肝程度呈强相关(Eta^(2)=0.586),与BMI呈中等相关(r_(s)=0.422,P<0.001),与FIB-4指数无相关性(r_(s)=-0.080、P=0.58),AC值联合BMI的模型预测MAFLD的ROC曲线下面积为0.869。模型最佳预测截点值为AC≥0.675 dB/cm/MHz、BMI≥22.05 kg/m^(2)。结论肝脏AC值在单纯肥胖及MAFLD儿童中均有增高,反映了肝脏脂肪变性的程度;UGAP定量AC值联合BMI可作为肥胖儿童预测MAFLD的危险因素。UGAP可作为临床筛查、诊断、评估肝脂肪变性严重程度及监测其进展的有效工具。

Objective To evaluate the value of ultrasound-guided attenuation parameter(UGAP)for evaluating the degree of metabolic dysfunction-associated fatty liver disease(MAFLD)in children.Methods One hundred and thirty-one children in which obesity was confirmed at Shenzhen Children's Hospital between May 2022 and February 2023 were retrospectively selected.According to the ultrasound findings,the patients were divided into two groups:MAFLD group(n=76)and simple obesity group(n=55).Fifty-eight sex-and age-matched healthy children were selected as a control group.The attenuation coefficient(AC)was compared among all groups and different hepatic steatosis grades.Correlation ratio(Eta^(2))and Spearman's correlation coefficient were used to assess the correlation between AC and the grade of hepatic steatosis,body mass index(BMI),fibrosis-4(FIB-4)index,and laboratory indices.Multivariate logistic regression analysis was used to construct an MAFLD predictive model.The diagnostic performance of the predictive model was evaluated by receiver operating characteristic(ROC)curve analysis.Results AC values in the MAFLD,simple obesity,and normal control groups were(0.758±0.076),(0.637±0.039),and 0.575(0.560,0.590)dB/cm/MHz,respectively.AC values in the patients with mild,moderate,and severe fatty liver were(0.728±0.067),(0.789±0.070),and(0.858±0.041)dB/cm/MHz,respectively.There were significant differences in AC values among different groups and hepatic steatosis grades(P<0.05 for all).There was a highly significant correlation between AC values and hepatic steatosis grades(Eta^(2)=0.586);a moderate correlation between AC values and BMI(r_(s)=0.422,P<0.001);but no correlation between AC values and FIB-4 index(r_(s)=-0.080,P=0.58).The equation of the MAFLD predictive model was:Logistic(P)=-22.081+0.242X(100AC)+0.233X(BMI).The area under the curve of the predictive model was 0.869.The cut-off values were AC≥0.675 dB/cm/MHz and BMI≥22.05 kg/m^(2).Conclusion AC values in the liver increase in children with simple obesity and those with MAFLD,which could reflect the grade of hepatic steatosis.AC values quantified using UGAP and BMI are predictors of MAFLD in children with obesity.UGAP might be an effective tool for clinical screening,diagnosis,and evaluation of hepatic steatosis severity and monitoring its progression.