Rockall A G, Sohaib S A, Evans D, Kaltsas G, Isidori A M, Monson J P, Besser G M, Grossman A B, Reznek R H
Department of Diagnostic Radiology, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
Eur J Endocrinol. 2003 Dec;149(6):543-8. doi: 10.1530/eje.0.1490543.
Hepatic steatosis may occur in association with insulin resistance and obesity, two features commonly seen in Cushing's syndrome (CS). The aim of this report is to assess the prevalence of hepatic steatosis in patients with active CS using computed tomography (CT) and to identify any associations between hepatic steatosis, endocrine and biochemical variables and body fat distribution.
We identified 50 patients with active CS in whom appropriate CT was available to allow measurement of liver and spleen attenuation. In 26 patients, abdominal fat measurements were also available. Serum markers of CS and liver function tests were recorded.
Ten of 50 patients had a liver-to-spleen CT attenuation ratio (L/S) of less than 1, indicating hepatic steatosis. There was a significant negative correlation between both liver attenuation and L/S ratio with total abdominal fat area, visceral fat area, the percentage of visceral fat and the visceral to subcutaneous fat ratio; the strongest negative correlation was found between visceral fat area and L/S ratio (r=-0.638, P<0.001, n=26). L/S ratio positively correlated with alkaline phosphatase levels (r=+0.423, P=0.044, n=23) but with no other serum marker of CS activity or liver enzyme.
We have demonstrated hepatic steatosis on CT in 20% of patients with active CS. The presence of hepatic steatosis was significantly correlated with total abdominal fat area and visceral fat area.
肝脂肪变性可能与胰岛素抵抗和肥胖相关，这是库欣综合征（CS）常见的两个特征。本报告的目的是使用计算机断层扫描（CT）评估活动性CS患者肝脂肪变性的患病率，并确定肝脂肪变性、内分泌和生化变量以及体脂分布之间的任何关联。
我们确定了50例活动性CS患者，他们有合适的CT图像可用于测量肝脏和脾脏的衰减值。其中26例患者还可进行腹部脂肪测量。记录了CS的血清标志物和肝功能检查结果。
50例患者中有10例肝脏与脾脏的CT衰减比（L/S）小于1，表明存在肝脂肪变性。肝脏衰减值和L/S比与总腹部脂肪面积、内脏脂肪面积、内脏脂肪百分比以及内脏与皮下脂肪比均呈显著负相关；内脏脂肪面积与L/S比之间的负相关性最强（r=-0.638，P<0.001，n=26）。L/S比与碱性磷酸酶水平呈正相关（r=+0.423，P=0.044，n=23），但与CS活性的其他血清标志物或肝酶无相关性。
我们通过CT证实20%的活动性CS患者存在肝脂肪变性。肝脂肪变性的存在与总腹部脂肪面积和内脏脂肪面积显著相关。
