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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (08) : 787 -794. doi: 10.3877/cma.j.issn.1672-6448.2023.08.001

小儿超声影像学

超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值
刘婷婷, 林妍冰, 汪珊, 陈幕荣, 唐子鉴, 代东伶, 夏焙†()   
  1. 518038　深圳，汕头大学医学院深圳儿科临床学院;518038　深圳市儿童医院超声医学科
    518038　深圳市儿童医院超声医学科
    518038　深圳市儿童医院消化内科
  • 收稿日期:2022-03-28 出版日期:2023-08-01
  • 通信作者: 夏焙
  • 基金资助:
    广东省高水平医院建设专项经费资助(深儿医科教科【2023】7号); 深圳市科技创新委员会基础研究（自由探索）项目(JCYJ20180228175150018)

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

Tingting Liu, Yanbing Lin, Shan Wang, Murong Chen, Zijian Tang, Dongling Dai, Bei Xia†()   

  1. Shenzhen Pediatrics Clinical College, Shantou University Medical College, Shenzhen 518038, China;Department of Ultrasound in Medicine, Shenzhen Children's Hospital, Shenzhen 518038, China
    Department of Ultrasound in Medicine, Shenzhen Children's Hospital, Shenzhen 518038, China
    Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen 518038, China
  • Received:2022-03-28 Published:2023-08-01
  • Corresponding author: Bei Xia
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刘婷婷, 林妍冰, 汪珊, 陈幕荣, 唐子鉴, 代东伶, 夏焙. 超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 787-794.

Tingting Liu, Yanbing Lin, Shan Wang, Murong Chen, Zijian Tang, Dongling Dai, Bei Xia. Evaluation of metabolic dysfunction-associated fatty liver disease in children by ultrasound-guided attenuation parameter[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 787-794.

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Eta2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（Eta2=0.586），与BMI呈中等相关（rs=0.422，P<0.001），与FIB-4指数无相关性（rs=-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/m2。

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。

关键词: 代谢相关脂肪性肝病, 超声衰减参数成像, 衰减系数, 儿童
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 (Eta2) 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 (Eta2=0.586); a moderate correlation between AC values and BMI (rs=0.422, P<0.001); but no correlation between AC values and FIB-4 index (rs=-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/m2.

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.

Key words: Metabolic dysfunction-associated fatty liver disease, Ultrasound-guided attenuation parameter, Attenuation coefficient, Children
图1 儿童肝脏超声衰减系数检测图。图a示健康儿童肝脏衰减系数（AC）0.57 dB/cm/MHz；图b示单纯肥胖儿童肝脏AC 0.63 dB/cm/MHz；图c示轻度脂肪肝AC 0.72 dB/cm/MHz；图d示中度脂肪肝AC 0.76 dB/cm/MHz；图e示重度脂肪肝AC 0.86 dB/cm/MHz（图中左图为质控图，右图为衰减测量图；扇形白框为采样框；矩形黄框为ROI测量区） 注：AC为衰减系数
表1 MAFLD组、单纯肥胖组及正常对照组一般资料比较
组别 例数 男性[例（%）] 年龄[岁，M（Q1，Q3），] BMI[kg/m2，M（Q1，Q3），] FIB-4（）
MAFLD组 76 55（21） 10.80（9.70，12.40） 25.58±5.07 0.18±0.06
单纯肥胖组 55 39（16） 10.37±1.92 22.54±4.36a 0.18±0.07
正常对照组 58 35（23） 10.46±2.13 18.05（15.20，22.76）ab -
统计值 χ2=2.330 H=4.341 H=40.271 t=0.441
P值 0.312 0.114 <0.001 0.661
表2 MAFLD组与单纯肥胖组实验室指标比较
组别 例数 TC（mmol/L，） LDL-C[mmol/L，，M（Q1，Q3）] TG（mmol/L，）
MAFLD组 76 4.32±0.86 2.89±0.84 1.40±0.67
单纯肥胖组 55 4.12±0.60 2.49（2.23，3.02） 1.07±0.45
统计值 t=-1.285 Z=774.500 t=-2.768
P值 0.202 0.067 0.007
组别 例数 HDL-C（mmol/L，） FBG[mmol/L，，M（Q1，Q3）] ALT[IU/L，M（Q1，Q3）] AST[IU/L，M（Q1，Q3）]
MAFLD组 76 1.13±0.18 4.60（4.43，4.90） 33.0（24.5，62.0） 27.0（21.0，37.0）
单纯肥胖组 55 1.24±0.21 4.83±0.34 17.0（14.0，27.0） 22.0（18.0，24.0）
统计值 t=2.631 Z=471.500 Z=472.500 Z=712.000
P值 0.010 0.076 <0.001 0.001
表3 AC值联合BMI预测MAFLD的Logistic回归分析
相关因素 β值 SE值 Wald χ2值 P值 OR值（95%CI）
100AC值 0.242 0.063 14.647 <0.001 1.274（1.125~1.442）
BMI 0.233 0.097 5.806 0.016 1.263（1.044~1.526）
常数 -22.081 5.358 16.983 <0.001
图2 衰减系数、体质量指数及二者联合预测代谢相关脂肪性肝病的ROC曲线 注：AC为衰减系数；BMI为体质量指数
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