肝周脂肪组织厚度：非酒精性脂肪肝的新无创标志物？

Perihepatic adipose tissue thickness: a new non-invasive marker of NAFLD?

机构信息

Department of Medical and Surgical Sciences;University of Padua Medical School, Italy.

出版信息

J Gastrointestin Liver Dis. 2009 Mar;18(1):61-6.

PMID:19337636

Abstract

BACKGROUND AND AIMS

Several non-invasive markers have been proposed to assess liver damage in NAFLD. We measured by ultrasound (US) the perihepatic adipose tissue thickness (PATT), i.e. the thickness of the fat between the abdominal muscular layer and the hepatic surface, in addition to waist circumference, BMI, biochemistry and serum adipokines, to predict the severity of liver damage in NAFLD.

METHODS

63 NAFLD patients and 45 controls were studied. PATT and US steatosis score were assessed in all patients. Histology was obtained in those with an US steatosis score greater or equal to 2.

RESULTS

PATT was 13.5 + or - 4.1 mm in NAFLD vs 8.0 + or - 4.1 in controls (p less than 0.001). A PATT value of 11.2 mm seems to represent a cut-off below which NAFLD is unlikely. Test sensitivity, specificity and the area under the ROC curve were 100%, 50% and 75%, respectively, suggesting a good discrimination between patients with non-NASH and those with NASH or borderline NASH. In addition, PATT strongly correlated with waist circumference (p less than 0.001). Both PATT and waist circumference correlated with US steatosis, HOMA-IR, TNF-alpha, IL-6 and leptin. Based on a multiple logistic regression analysis, waist circumferences greater or equal to 110, 113 and 122 cm were associated with a probability over or equal to 50% of abnormal HOMA-IR, TNF-alpha and leptin values, respectively.

CONCLUSION

PATT and waist circumference could represent non-invasive markers predicting the severity of liver damage in NAFLD.

摘要

背景与目的

有几种非侵入性标志物已被提出用于评估非酒精性脂肪性肝病（NAFLD）中的肝损伤。我们通过超声（US）测量了肝周脂肪组织厚度（PATT），即腹部肌肉层和肝表面之间的脂肪厚度，此外还测量了腰围、BMI、生化指标和血清脂肪因子，以预测 NAFLD 中肝损伤的严重程度。

方法

研究了 63 例 NAFLD 患者和 45 例对照者。所有患者均评估了 PATT 和 US 脂肪变性评分。对于 US 脂肪变性评分≥2 的患者，进行了肝组织学检查。

结果

NAFLD 患者的 PATT 为 13.5±4.1mm，对照组为 8.0±4.1mm（p＜0.001）。PATT 值为 11.2mm 似乎代表了一个截断值，低于该值则不太可能患有 NAFLD。检测的敏感性、特异性和 ROC 曲线下面积分别为 100%、50%和 75%，提示 PATT 能够很好地区分非 NASH 患者和 NASH 或边界性 NASH 患者。此外，PATT 与腰围强烈相关（p＜0.001）。PATT 和腰围均与 US 脂肪变性、HOMA-IR、TNF-α、IL-6 和瘦素相关。基于多因素逻辑回归分析，腰围≥110、113 和 122cm 与 HOMA-IR、TNF-α和瘦素异常值的概率≥50%相关。