Quantitative analysis of hepatic steatosis in patients with hypertriglyceridemia using ultrasound derived fat fraction: a preliminary study

doi:10.3877/cma.j.issn.1672-6448.2026.01.004

Abstract

Abstract:

Objective

To evaluate the value of ultrasound derived fat fraction (UDFF) in the quantitative assessment of hepatic steatosis in patients with varying degrees of hypertriglyceridemia (HTG).

Methods

A total of 156 HTG patients and 40 healthy controls who visited Xiyuan Hospital, China Academy of Chinese Medical Sciences from October 2023 to December 2024 were enrolled. Clinical data, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), ultrasound grade of fatty liver, subcutaneous fat thickness (SFT), visceral fat thickness (VFT), and UDFF were collected. HTG patients were divided into two groups based on TG levels: borderline elevated TG group (1.7≤TG＜2.3 mmol/L, n=63) and elevated TG group (2.3≤TG＜5.7 mmol/L, n=93). The intra-observer consistency of UDFF measurements was evaluated, differences in UDFF were compared among groups, and its correlation with clinical indicators was analyzed.

Results

The intra-observer consistency of UDFF measurements was excellent (intra-class correlation coefficient=0.971, P＜0.001). The UDFF value in the HTG group was significantly higher than that of the control group (11.0% vs 5.0%, P＜0.001). UDFF showed an increasing trend with rising TG levels: control group (5.0%) ＜borderline elevated TG group (6.0%)＜elevated TG group (15.0%), with statistically significant differences in pairwise comparisons (P＜0.05). In HTG patients, UDFF was positively correlated with fatty liver grade, TG, and VFT (r=0.817, 0.745, and 0.641, respectively; P＜0.001) and negatively correlated with HDL-C (r=-0.546, P＜0.001). Multiple linear regression analysis revealed that fatty liver grade (β=0.390), TG (β=0.402), VFT (β=0.170), and SFT (β=0.121) were independent risk factors for UDFF (R²=0.819).

Conclusion

UDFF is significantly correlated with the grade of fatty liver and metabolic indicators in HTG patients, enabling early identification and quantitative assessment of hepatic steatosis in this population.

Key words: Hypertriglyceridemia, Hepatic steatosis, Ultrasound derived fat fraction, Quantitative evaluation

Yuanyuan Wang, Yunlin Li, Jingbo Guan, Min Sun, Yaning Xie, Dakun Zhang, Zihao Zhang. Quantitative analysis of hepatic steatosis in patients with hypertriglyceridemia using ultrasound derived fat fraction: a preliminary study[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2026, 23(01): 23-29.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2026.01.004

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Figures/Tables 5

资料	对照组（n=40）	HTG组（n=156）	统计值	P值
年龄（岁， $x ¯$ ±s）	45.78±6.61	46.37±9.74	t=0.458	0.648
性别[男，例（%）]	17（42.5）	87（55.8）	χ²=7.818	0.134
身高（cm， $x ¯$ ±s）	166.18±6.40	167.69±8.34	t=1.251	0.215
体重（kg， $x ¯$ ±s）	63.65±9.89	74.56±14.38	t=5.621	＜0.001
BMI（kg/m²， $x ¯$ ±s）	22.95±2.74	26.40±4.22	t=6.267	＜0.001
TC（mmol/L， $x ¯$ ±s）	5.03±0.70	5.09±0.81	t=0.465	0.642
TG（mmol/L， $x ¯$ ±s）	1.08±0.47	2.90±1.08	t=16.003	＜0.001
HDL-C（mmol/L， $x ¯$ ±s）	1.23±0.42	1.18±0.39	t=-0.762	0.047
LDL-C（mmol/L， $x ¯$ ±s）	2.75±0.54	2.86±0.73	t=0.881	0.379
SFT（cm， $x ¯$ ±s）	2.05±0.68	2.49±0.82	t=3.536	0.001
VFT（cm， $x ¯$ ±s）	3.73±1.32	4.96±1.84	t=3.978	＜0.001
脂肪肝分级[例（%）]			Z=-5.749	＜0.001
无	24（60.0）	33（21.2）
轻度	16（40.0）	54（34.6）
中度	0	33（21.2）
重度	0	36（23.0）
UDFF[%，M（Q₁，Q₃）]	5.0（4.0，6.0）	11.0（6.0，17.0）	Z=-6.263	＜0.001

资料	对照组（n=40）	HTG组（n=156）	统计值	P值
年龄（岁， $x ¯$ ±s）	45.78±6.61	46.37±9.74	t=0.458	0.648
性别[男，例（%）]	17（42.5）	87（55.8）	χ²=7.818	0.134
身高（cm， $x ¯$ ±s）	166.18±6.40	167.69±8.34	t=1.251	0.215
体重（kg， $x ¯$ ±s）	63.65±9.89	74.56±14.38	t=5.621	＜0.001
BMI（kg/m²， $x ¯$ ±s）	22.95±2.74	26.40±4.22	t=6.267	＜0.001
TC（mmol/L， $x ¯$ ±s）	5.03±0.70	5.09±0.81	t=0.465	0.642
TG（mmol/L， $x ¯$ ±s）	1.08±0.47	2.90±1.08	t=16.003	＜0.001
HDL-C（mmol/L， $x ¯$ ±s）	1.23±0.42	1.18±0.39	t=-0.762	0.047
LDL-C（mmol/L， $x ¯$ ±s）	2.75±0.54	2.86±0.73	t=0.881	0.379
SFT（cm， $x ¯$ ±s）	2.05±0.68	2.49±0.82	t=3.536	0.001
VFT（cm， $x ¯$ ±s）	3.73±1.32	4.96±1.84	t=3.978	＜0.001
脂肪肝分级[例（%）]			Z=-5.749	＜0.001
无	24（60.0）	33（21.2）
轻度	16（40.0）	54（34.6）
中度	0	33（21.2）
重度	0	36（23.0）
UDFF[%，M（Q₁，Q₃）]	5.0（4.0，6.0）	11.0（6.0，17.0）	Z=-6.263	＜0.001

资料	对照组（n=40）	TG边缘升高组（n=63）	TG升高组（n=93）	统计值	P值
年龄（岁）	45.78±6.61	46.67±10.19	46.17±9.47	F=0.121	0.886
性别[男，例（%）]	17（42.5）	35（55.6）	52（55.9）	χ²=2.253	0.324
身高（cm， $x ¯$ ±s）	166.18±6.40	167.38±8.84	167.90±8.03	F=0.651	0.522
体重（kg， $x ¯$ ±s）	63.65±9.89	71.83±13.39^a	76.42±14.79^ab	F=12.619	＜0.001
BMI（kg/m²， $x ¯$ ±s）	22.95±2.75	25.49±3.35^a	27.01±4.64^ab	F=15.115	＜0.001
TC（mmol/L， $x ¯$ ±s）	5.03±0.70	4.98±0.83	5.16±0.78	F=1.068	0.346
TG（mmol/L， $x ¯$ ±s）	1.08±0.47	1.98±0.13^a	3.53±0.99^ab	F=19.648	＜0.001
HDL-C（mmol/L， $x ¯$ ±s）	1.23±0.42	1.32±0.47	1.09±0.28^ab	F=7.270	0.001
LDL-C（mmol/L， $x ¯$ ±s）	2.75±0.54	2.84±0.79	2.87±0.70	F=0.421	0.657
SFT（cm， $x ¯$ ±s）	2.05±0.68	2.11±0.68	2.75±0.80^ab	F=19.883	＜0.001
VFT（cm， $x ¯$ ±s）	3.73±1.32	3.97±1.46	5.62±1.77^ab	F=16.895	＜0.001
脂肪肝分级[例（%）]				H=63.060	＜0.001
无	24（60.0）	23（36.5）	10（10.8）^ab
轻度	16（40.0）	33（52.4）	21（22.6）^ab
中度	0	5（7.9）	28（30.0）^ab
重度	0	2（3.2）	34（36.6）^ab
UDFF[%，M（Q₁，Q₃）]	5.0（4.0，6.0）	6.0（5.0，9.0）^a	15.0（11.0，24.0）^ab	H=9.569	＜0.001

资料	对照组（n=40）	TG边缘升高组（n=63）	TG升高组（n=93）	统计值	P值
年龄（岁）	45.78±6.61	46.67±10.19	46.17±9.47	F=0.121	0.886
性别[男，例（%）]	17（42.5）	35（55.6）	52（55.9）	χ²=2.253	0.324
身高（cm， $x ¯$ ±s）	166.18±6.40	167.38±8.84	167.90±8.03	F=0.651	0.522
体重（kg， $x ¯$ ±s）	63.65±9.89	71.83±13.39^a	76.42±14.79^ab	F=12.619	＜0.001
BMI（kg/m²， $x ¯$ ±s）	22.95±2.75	25.49±3.35^a	27.01±4.64^ab	F=15.115	＜0.001
TC（mmol/L， $x ¯$ ±s）	5.03±0.70	4.98±0.83	5.16±0.78	F=1.068	0.346
TG（mmol/L， $x ¯$ ±s）	1.08±0.47	1.98±0.13^a	3.53±0.99^ab	F=19.648	＜0.001
HDL-C（mmol/L， $x ¯$ ±s）	1.23±0.42	1.32±0.47	1.09±0.28^ab	F=7.270	0.001
LDL-C（mmol/L， $x ¯$ ±s）	2.75±0.54	2.84±0.79	2.87±0.70	F=0.421	0.657
SFT（cm， $x ¯$ ±s）	2.05±0.68	2.11±0.68	2.75±0.80^ab	F=19.883	＜0.001
VFT（cm， $x ¯$ ±s）	3.73±1.32	3.97±1.46	5.62±1.77^ab	F=16.895	＜0.001
脂肪肝分级[例（%）]				H=63.060	＜0.001
无	24（60.0）	23（36.5）	10（10.8）^ab
轻度	16（40.0）	33（52.4）	21（22.6）^ab
中度	0	5（7.9）	28（30.0）^ab
重度	0	2（3.2）	34（36.6）^ab
UDFF[%，M（Q₁，Q₃）]	5.0（4.0，6.0）	6.0（5.0，9.0）^a	15.0（11.0，24.0）^ab	H=9.569	＜0.001

因素	非标准化系数		标准化系数	t	P	VIF	R²	调整R²	F
因素	B	标准误	β	t	P	VIF	R²	调整R²	F
常数	-8.096	1.131		-7.157	＜0.001		0.819	0.814	F=170.992 P＜0.001
TG	3.236	0.412	0.402	7.857	＜0.001	2.191
脂肪肝分级	3.168	0.380	0.390	8.346	＜0.001	1.827
VFT	0.802	0.221	0.170	3.625	＜0.001	1.837
SFT	1.288	0.426	0.121	3.025	0.003	1.340

References 19

1	Song PK, Man QQ, Li H, et al. Trends in lipids level and dyslipidemia among Chinese adults,2002-2015[J]. Biomed Environ Sci, 2019, 32(8): 559-570.
2	Younossi Z, Tacke F, Arrese M, et al.Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[J]. Hepatology, 2019, 69(6): 2672-2682.
3	De Robertis R, Spoto F, Autelitano D, et al. Ultrasound-derived fat fraction for detection of hepatic steatosis and quantification of liver fat content[J]. Radiol Med, 2023, 128(10): 1174-1180.
4	Zalcman M, Barth RA, Rubesova E. Real-time ultrasound-derived fat fraction in pediatric population:feasibility validation with MR-PDFF[J]. Pediatr Radiol, 2023, 53(12): 2466-2475.
5	Xia T, Du M, Li H, et al. Association between liver MRI proton density fat fraction and liver disease risk[J]. Radiology, 2023, 309(1): E231007.
6	孟令芝, 施宁尧, 杨宗利. 基于超声脂肪定量技术(UDFF)评估多囊卵巢综合征患者肝脏脂肪含量的研究[J]. 临床医学进展, 2024, 14(4): 290-296.
7	高甘油三酯血症临床管理多学科专家共识工作组,葛均波,霍勇,等.高甘油三酯血症临床管理多学科专家共识[J]. 中国循环杂志, 2023, 38(6): 621-633.
8	Cao W, An X, Cong L, et al.Application of deep learning in quantitative analysis of 2-dimensional ultrasound imaging of nonalcoholic fatty liver disease[J]. J Ultrasound Med, 2020, 39(1): 51-59.
9	Eslam M, Sanyal AJ, George J. MAFLD:a consensus-driven proposed nomenclature for metabolic associated fatty liver disease[J]. Gastroenterology, 2020, 158(7): 1999-2014.
10	Chen YL, Li H, Li S, et al. Prevalence of and risk factors for metabolic associated fatty liver disease in an urban population in China:a cross-sectional comparative study[J]. BMC Gastroenterol, 2021, 21(1): 212.
11	魏文敏. 血脂指标联合血清转氨酶、胆碱酯酶及γ-谷氨酰转肽酶检测在非酒精性脂肪肝诊断中的应用[J]. 中外医学研究, 2024, 22(20): 78-81.
12	Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease[J]. Lancet, 2021, 397(10290): 2212-2224.
13	Yoshiko N, Masashi H, Yohei K, et al. Diagnostic accuracy of ultrasound derived fat fraction for the detection and quantification of hepatic steatosis in patients with liver biopsy[J]. J Med Ultrason, 2024, 52(3): 561-562.
14	王米雪, 单涛, 于静, 等.超声脂肪定量评估慢性肝病合并脂肪变与病理对照研究[J]. 中国超声医学杂志, 2025, 41(2): 161-164.
15	Qi R, Lu L, He T, et al. Comparing ultrasound-derived fat fraction and MRI-PDFF for quantifying hepatic steatosis:a real-world prospective study[J]. Eur Radiol, 2025, 35(5): 2580-2588.
16	黄韵琳, 董怡, 程娟, 等. 超声脂肪分数定量检测肝脂肪变性的可靠性研究[J]. 肿瘤影像学, 2023, 32(4): 324-327.
17	Yanai H, Adachi H, Hakoshima M, et al.Metabolic-dysfunction-associated steatotic liver disease—its pathophysiology,association with atherosclerosis and cardiovascular disease,and treatments[J]. Int J Mol Sci, 2023, 24(20): 15473.
18	Meng L, Wang J, Yang H, et al.Ultrasound-derived fat fraction to assess liver steatosis in obese patients with polycystic ovary syndrome[J]. Clin Exp Med, 2025, 25(1): 130.
19	龙智慧, 刘健, 王鹏, 等. 非酒精性人群肝脏脂肪含量的CT定量测量及肝脏脂肪含量影响因素研究[J]. 中国中西医结合影像学杂志, 2023, 21(4): 440-443,447.

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[14]	Yuanmei Gao, Guangyuan Liao, Jing Li, Lichan Wu, Dongjian Huang, Zhong Xu, Dunjin Chen. Comparative study on effect of different anticoagulators on veno-venous hemofiltration treating hypertriglyceridemia-induced acute pancreatitis in pregnancy [J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2017, 03(04): 227-231.
[15]	Jiaxi Han, Xiangmin Fan, Ning Su. The usage of digital technology evaluation methods in the diagnosis and treatment of neurologic movement disorders [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(03): 275-279.

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