Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.
Department of Radiology, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.
Liver Int. 2018 May;38(5):915-923. doi: 10.1111/liv.13558. Epub 2017 Sep 21.
BACKGROUND & AIMS: Evaluation of the controlled attenuation parameter (CAP) is a promising noninvasive method for assessing hepatic steatosis. Despite the increasing reliability of the CAP for assessing steatosis in subjects with chronic liver disease, few studies have evaluated the CAP in asymptomatic subjects without overt liver disease. Therefore, we aimed to evaluate the usefulness of the CAP for a health check-up population.
We enrolled subjects who underwent abdominal ultrasonography (US), FibroScan (Echosens, France) and blood sampling during medical health check-ups. The CAP was measured using FibroScan, and increased CAP was defined as CAP ≥ 222 dB/m.
A total of 1133 subjects were included; 589 subjects (52.0%) had fatty liver based on US, and 604 subjects (53.3%) had increased CAP. Increased CAP was significantly associated with metabolic abnormalities, including higher body mass index (BMI)[odds ratio (OR) = 1.33;95% confidence interval (CI),1.24-1.43; P < .001], higher alanine aminotransferase (ALT) (OR = 1.02; 95% CI, 1.01-1.04; P = .003), higher insulin (OR = 1.04; 95% CI, 1.00-1.08; P = .037), higher triglyceride (OR = 1.00; 95% CI, 1.00-1.01; P = 0.042) and older age (OR = 1.02; 95% CI, 1.00-1.03; P = .05). Furthermore, a comparison of clinical parameters among three groups (normal vs no fatty liver by US but increased CAP vs fatty liver based on US) revealed that metabolic parameters, including blood pressure, BMI, waist circumference, aspartate aminotransferase (AST), ALT, triglycerides, fasting glucose, uric acid, insulin, homeostasis model assessment-estimated insulin resistance and liver stiffness measurements, gradually increased across the three groups (all P < .001).
In conclusion, increased CAP could be an early indicator of fatty liver disease with metabolic abnormalities that manifests even before a sonographic fatty change appears.
评估受控衰减参数（CAP）是一种有前途的非侵入性方法，可用于评估肝脂肪变性。尽管 CAP 对于评估慢性肝病患者的脂肪变性越来越可靠，但很少有研究评估无症状且无明显肝脏疾病的患者的 CAP。因此，我们旨在评估 CAP 在健康检查人群中的有用性。
我们招募了在医疗健康检查期间接受腹部超声（US）、FibroScan（Echosens，法国）和血液采样的受试者。使用 FibroScan 测量 CAP，定义 CAP≥222dB/m 为 CAP 升高。
共纳入 1133 名受试者；589 名受试者（52.0%）根据 US 诊断为脂肪肝，604 名受试者（53.3%）CAP 升高。CAP 升高与代谢异常显著相关，包括更高的体重指数（BMI）[比值比（OR）=1.33；95%置信区间（CI），1.24-1.43；P<0.001]、更高的丙氨酸转氨酶（ALT）（OR=1.02；95%CI，1.01-1.04；P=0.003）、更高的胰岛素（OR=1.04；95%CI，1.00-1.08；P=0.037）、更高的甘油三酯（OR=1.00；95%CI，1.00-1.01；P=0.042）和更高龄（OR=1.02；95%CI，1.00-1.03；P=0.05）。此外，对三组（US 正常且无脂肪肝但 CAP 升高 vs US 诊断为脂肪肝）的临床参数进行比较后发现，包括血压、BMI、腰围、天冬氨酸转氨酶（AST）、ALT、甘油三酯、空腹血糖、尿酸、胰岛素、稳态模型评估-估计的胰岛素抵抗和肝硬度测量在内的代谢参数逐渐升高（均 P<0.001）。
总之，CAP 升高可能是代谢异常的脂肪肝的早期指标，即使在超声出现脂肪变化之前也会出现这种情况。
