腹部脂肪CT定量参数联合肝/脾CT值比值对NAFLD患者肝脂肪变性程度及合并CAS斑块风险的评估价值

Evaluation value of abdominal fat CT quantitative parameters combined with CT value ratio of liver to spleen for the degree of hepatic steatosis and risk of concomitant CAS plaques in patients with NAFLD

目的探讨腹部脂肪CT定量参数联合肝/脾CT值比值(CTL/S)对非酒精性脂肪性肝病(NAFLD)患者肝脂肪变性程度及合并颈动脉粥样硬化(CAS)斑块风险的评估价值。方法前瞻性研究并选取2019年1月至2022年1月阳泉市第一人民医院收治的NAFLD患者180例(观察组),其中男性96例、女性84例,年龄(64.6±6.9)岁,范围35~78岁;选取同期阳泉市第一人民医院体检中心的健康体检者45例(对照组),其中男性25例、女性20例,年龄(64.3±5.1)岁,范围33~79岁;2组受检者均行腹部CT检查。测量观察组患者的颈动脉内膜中层厚度(IMT),并根据IMT结果将观察组患者分为NAFLD合并CAS斑块组(IMT≥1.2 mm)和单纯NAFLD组(IMT<1.2 mm)。比较观察组和对照组受检者的CTL/S、内脏脂肪面积(VFA)、总脂肪面积(TFA)、脐水平面的矢状径(以下简称矢状径)、肌间脂肪面积(IMFA)。比较NAFLD合并CAS斑块组与单纯NAFLD组患者的CTL/S、VFA、TFA、矢状径、IMFA和肝脂肪变性程度。2组间计量资料的比较采用t检验,计数资料的比较采用χ^(2)检验。采用多因素Logistic回归分析明确NAFLD合并CAS斑块的独立危险因素,并采用受试者工作特征(ROC)曲线分析其对NAFLD合并CAS斑块的诊断价值,采用Spearman法分析其与NAFLD患者肝脂肪变性程度的相关性。结果观察组的CTL/S低于对照组(0.59±0.10对0.86±0.12),且差异均有统计学意义(t=15.539,P<0.001);VFA[(173.80±22.42)cm2对(139.82±21.46)cm2]、TFA[(407.23±41.82)cm2对(365.71±36.85)cm2]、矢状径[(22.90±1.55)cm对(20.06±1.47)cm]均高于对照组,且差异均有统计学意义(t=9.273、6.200、11.237,均P<0.001)。NAFLD合并CAS斑块组的CTL/S(0.49±0.12对0.63±0.15)、NAFLD轻度肝脂肪变性占比(35.29%对66.67%)均低于单纯NAFLD组,且差异均有统计学意义(t=5.952,χ^(2)=14.746,均P<0.001);VFA[(190.69±24.17)cm2对(167.13±22.15)cm2]、TFA[(442.17±46.22)cm2对(393.42±40.87)cm2]、矢状径[(24.80±2.04)cm对(22.15±1.81)cm]、NAFLD重度肝脂肪变性占比(33.33%对11.63%)均高于单纯NAFLD组,且差异均有统计学意义(t=6.265、6.944、8.533,χ^(2)=11.780,均P<0.001)。多因素Logistic回归分析结果显示,CTL/S(OR=2.537,95%CI:1.412~4.659)、VFA(OR=1.225,95%CI:1.101~2.460)、TFA(OR=1.354,95%CI:1.025~3.074)、矢状径(OR=3.815,95%CI:2.030~7.172)均为NAFLD合并CAS斑块的独立危险因素(均P<0.05);ROC曲线分析结果显示,CTL/S、VFA、TFA、矢状径联合诊断NAFLD合并CAS斑块的曲线下面积最大(0.963),灵敏度为84.31%,特异度为97.67%。NAFLD患者的CTL/S与肝脂肪变性程度呈负相关(r=-0.571,P<0.001),VFA、TFA、矢状径与肝脂肪变性程度均呈正相关(r=0.635、0.317、0.622,均P<0.001)。结论腹部脂肪CT定量参数和CTL/S与NAFLD患者肝脂肪变性程度密切相关,且CTL/S、VFA、TFA、矢状径联合诊断对鉴别NAFLD合并CAS斑块可能具有一定的潜在价值。

Objective To explore the value of abdominal fat CT quantitative parameters combined with the CT value ratio of liver to spleen(CTL/S)in evaluating the degree of hepatic steatosis and risk of concomitant carotid atherosclerosis(CAS)plaques in patients with non-alcoholic fatty liver disease(NAFLD).Methods A prospective study was conducted,and 180 patients with NAFLD(observation group)admitted to Yangquan First People's Hospital from January 2019 to January 2022 were selected.They included 96 males and 84 females aged(64.6±6.9)years with ages that ranged from 35 years to 78 years.A total of 45 healthy subjects(control group)were selected from the physical examination center of Yangquan First People's Hospital during the same period.They included 25 males and 20 females aged(64.3±5.1)years with ages that spanned 33 years to 79 years.Abdominal CT examination was performed on both groups.The carotid intima-media thickness(IMT)of patients in the observation group was measured,and the observation group was divided into groups with NAFLD combined with CAS plaques(IMT≥1.2 mm)or NAFLD alone(IMT<1.2 mm)on the basis of IMT results.CTL/S,visceral fat area(VFA),total fat area(TFA),sagittal diameter at the umbilical level(hereinafter referred to as sagittal diameter),and intermuscular fat area(IMFA)were compared between the observation and control groups.CTL/S,VFA,TFA,sagittal diameter,IMFA,and degree of hepatic steatosis were compared between NAFLD combined with CAS plaques group and NAFLD alone group.Measurement data between two groups were compared by t test,while counting data were compared byχ^(2) test.Multivariate Logistic regression analysis was used to identify independent risk factors for NAFLD combined with CAS plaques,and receiver operating characteristic(ROC)curves were applied to analyze its diagnostic value for NAFLD combined with CAS plaques,and Spearman's method was employed to analyze its correlation with the degree of hepatic steatosis in patients with NAFLD.Results The CTL/S of the observation group was significantly lower than that of the control group(0.59±0.10 vs.0.86±0.12;t=15.539,P<0.001).The VFA((173.80±22.42)cm2 vs.(139.82±21.46)cm2),TFA((407.23±41.82)cm2 vs.(365.71±36.85)cm2),and sagittal diameter((22.90±1.55)cm vs.(20.06±1.47)cm)of the observation group were significantly higher than those of the control group(t=9.273,6.200,11.237,all P<0.001).The CTL/S(0.49±0.12 vs.0.63±0.15)and proportion of mild hepatic steatosis(35.29%vs.66.67%)in patients of NAFLD combined with CAS plaques group were significantly lower than those in patients of NAFLD alone group(t=5.952,χ^(2)=14.746,both P<0.001).VFA((190.69±24.17)cm2 vs.(167.13±22.15)cm2),TFA((442.17±46.22)cm2 vs.(393.42±40.87)cm2),sagittal diameter((24.80±2.04)cm vs.(22.15±1.81)cm),and the proportion of severe hepatic steatosis(33.33%vs.11.63%)in patients of NAFLD combined with CAS plaques group were significantly higher than those in patients of NAFLD alone group(t=6.265,6.944,8.533,χ^(2)=11.780,all P<0.001).Multivariate Logistic regression analysis results showed that CTL/S(OR=2.537,95%CI:1.412–4.659),VFA(OR=1.225,95%CI:1.101–2.460),TFA(OR=1.354,95%CI:1.025–3.074),and sagittal diameter(OR=3.815,95%CI:2.030–7.172)were all independent risk factors for NAFLD combined with CAS plaques(all P<0.05).The results of ROC curve analysis revealed that the combination of CTL/S,VFA,TFA,and sagittal diameter had the largest area under the curve for the diagnosis of NAFLD combined with CAS plaques(0.963)and showed a sensitivity of 84.31%and specificity of 97.67%.The CTL/S of patients with NAFLD was negatively correlated with the degree of hepatic steatosis(r=−0.571,P<0.001),and VFA,TFA,and sagittal diameter were all positively correlated with the degree of hepatic steatosis(r=0.635,0.317,and 0.622,all P<0.001).Conclusion Abdominal fat CT quantitative parameters and CTL/S are closely related to the degree of hepatic steatosis in patients with NAFLD,and the combined detection of CTL/S,VFA,TFA,and sagittal diameter may have certain potential value in distinguishing NAFLD combined with CAS plaques.