在肥胖的 HIV 感染成年人中，受控衰减参数和磁共振波谱测量的肝脂肪变性不一致。
Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults.
机构信息
aDepartment of Medicine bDepartment of Surgery, University of California, San Francisco cDepartment of Veteran Affairs Medical Center, Medical Service dDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
出版信息
AIDS. 2017 Sep 24;31(15):2119-2125. doi: 10.1097/QAD.0000000000001601.
OBJECTIVE
Hepatic steatosis is common in HIV-infected individuals. Magnetic resonance spectroscopy (MRS) is the preferred noninvasive method for hepatic steatosis measurement but is expensive. Controlled attenuation parameter (CAP) also assesses hepatic steatosis and is conveniently performed concomitantly with transient elastography. We aimed to assess the accuracy of CAP in the setting of HIV infection.
DESIGN
Cross-sectional study.
METHODS
CAP and MRS were performed in 82 study participants (39 HIV monoinfected; seven hepatitis C virus (HCV) monoinfected; 21 HIV/HCV coinfected; 15 with neither infection). We used concordance correlation coefficients to compare log-transformed and standardized CAP and MRS values and linear regression to examine factors associated with CAP and MRS-measured hepatic steatosis (MRS-HS). The accuracy of CAP to detect at least mild hepatic steatosis, defined as MRS-liver fat fraction more than 0.05, and the factors associated with discordance between CAP and MRS were evaluated.
RESULTS
Overall, CAP-measured hepatic steatosis and MRS-HS correlated moderately well (rc = 0.63; P < 0.001), and correlation was strongest in the HIV-monoinfected group (rc = 0.67; P < 0.001). Body composition factors (higher BMI, waist circumference, visceral and abdominal subcutaneous adipose tissue) and insulin resistance were significantly associated with both greater CAP-measured hepatic steatosis and MRS-HS. Using a validated CAP cut-off of at least 238 dB/m, sensitivity and specificity for at least mild hepatic steatosis were 84% and 75% in the entire cohort; 89% and 80% in the HIV-monoinfected group. Participants with higher body composition parameters were more likely to be misclassified as having hepatic steatosis by CAP.
CONCLUSION
Our findings suggest CAP is an acceptable noninvasive surrogate for hepatic steatosis in HIV-infected individuals but may overestimate hepatic steatosis prevalence, especially in individuals with high BMI. Evaluation of factors that improve CAP accuracy and determination of optimal cut-offs are warranted.
目的
肝脂肪变性在感染 HIV 的个体中很常见。磁共振光谱（MRS）是测量肝脂肪变性的首选非侵入性方法，但价格昂贵。受控衰减参数（CAP）也可评估肝脂肪变性，并且方便地与瞬时弹性成像同时进行。我们旨在评估 CAP 在 HIV 感染中的准确性。
设计
横断面研究。
方法
在 82 名研究参与者（39 名 HIV 单一感染者；7 名丙型肝炎病毒（HCV）单一感染者；21 名 HIV/HCV 合并感染者；15 名无感染）中进行 CAP 和 MRS。我们使用一致性相关系数来比较对数转换和标准化的 CAP 和 MRS 值，并使用线性回归来检查与 CAP 和 MRS 测量的肝脂肪变性（MRS-HS）相关的因素。评估 CAP 检测至少轻度肝脂肪变性（定义为 MRS-肝脂肪分数大于 0.05）的准确性，以及与 CAP 和 MRS 之间差异相关的因素。
结果
总体而言，CAP 测量的肝脂肪变性与 MRS-HS 中度相关（rc=0.63；P<0.001），在 HIV 单一感染者组中相关性最强（rc=0.67；P<0.001）。身体成分因素（更高的 BMI、腰围、内脏和腹部皮下脂肪组织）和胰岛素抵抗与 CAP 测量的肝脂肪变性和 MRS-HS 均显著相关。使用至少 238dB/m 的验证性 CAP 临界值，整个队列中 CAP 检测至少轻度肝脂肪变性的敏感性和特异性分别为 84%和 75%；在 HIV 单一感染者组中，分别为 89%和 80%。身体成分参数较高的参与者更有可能被 CAP 错误分类为患有肝脂肪变性。
结论
我们的发现表明，CAP 是 HIV 感染者肝脂肪变性的一种可接受的非侵入性替代方法，但可能高估肝脂肪变性的患病率，尤其是在 BMI 较高的个体中。评估改善 CAP 准确性的因素和确定最佳临界值是必要的。
Zotero 插件