Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing 211166, China.
Department of Infectious Disease, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhou Road, Nanjing 210003, China.
Clin Res Hepatol Gastroenterol. 2022 Oct;46(8):101951. doi: 10.1016/j.clinre.2022.101951. Epub 2022 May 21.
The prevalence of non-alcoholic fatty liver disease (NAFLD) in China as assessed using vibration-controlled transient elastography (VCTE) and its consistency with ultrasound is still unknown. We aimed to conduct a head-to-head comparison of consecutive measurements of NAFLD with ultrasound or VCTE to evaluate the discrepancy in the prevalence and distribution of NAFLD screened by two non-invasive techniques.
We collected VCTE and ultrasound examination data from 4,388 participants who underwent health check-ups at the Health Promotion Center of Jiangsu Province Hospital between January 2017 and December 2019. The major outcome was the presence of hepatic steatosis, which was defined as a median controlled attenuation parameter (CAP) ≥ 248 dB/m by VCTE or the definition of steatosis by ultrasound.
Among the 4,388 participants, 2,214 were diagnosed with NAFLD by VCTE (CAP ≥ 248 dB/m, 50.46%). Participants with severe steatosis (CAP ≥ 280 dB/m) were commonly male (77.94% vs. 50.38%, P < 0.001), were obese (45.09% vs. 1.79%, P < 0.001), had a worse metabolic profile, had elevated liver enzyme levels, and had advanced fibrosis. The prevalence of ultrasound-diagnosed NAFLD was 56.42%. After consistency analysis, VCTE and ultrasound showed moderate agreement regarding the diagnosis of NAFLD (κ = 0.475). We then compared the characteristics and clinical features of the four groups classified by the diagnosis results of the two techniques. NAFLD participants diagnosed by VCTE only were older, more obese, and had worse metabolic and biochemical profiles than NAFLD participants diagnosed by ultrasound only; in particular, the former had a higher proportion of abnormal alanine aminotransferase and aspartate aminotransferase levels and a higher proportion of advanced fibrosis than the latter.
More than half of Chinese adults were affected by NAFLD according to VCTE. Screening based on VCTE is more likely to identify NAFLD patients with severe clinical features than ultrasound. Therefore, VCTE is a more practical non-invasive tool for the screening and follow-up of NAFLD in China.
使用振动控制瞬时弹性成像（VCTE）评估中国非酒精性脂肪性肝病（NAFLD）的流行率及其与超声的一致性尚不清楚。我们旨在对头对头比较超声或 VCTE 连续测量 NAFLD，以评估两种非侵入性技术筛查的 NAFLD 的患病率和分布差异。
我们收集了 2017 年 1 月至 2019 年 12 月期间在江苏省医院健康促进中心接受健康检查的 4388 名参与者的 VCTE 和超声检查数据。主要结局是肝脂肪变性的存在，其定义为 VCTE 中中位数控制衰减参数（CAP）≥248dB/m 或超声定义的脂肪变性。
在 4388 名参与者中，2214 名（50.46%）被 VCTE 诊断为 NAFLD（CAP≥248dB/m）。CAP≥280dB/m 的严重脂肪变性患者通常为男性（77.94%比 50.38%，P<0.001）、肥胖（45.09%比 1.79%，P<0.001）、代谢谱较差、肝酶水平升高和纤维化进展。超声诊断为 NAFLD 的患病率为 56.42%。在一致性分析后，VCTE 和超声在诊断 NAFLD 方面显示出中度一致性（κ=0.475）。然后，我们比较了根据两种技术的诊断结果进行分类的四组的特征和临床特征。仅通过 VCTE 诊断的 NAFLD 患者比仅通过超声诊断的 NAFLD 患者年龄更大、更肥胖，且代谢和生化特征更差；特别是前者的丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平异常的比例以及晚期纤维化的比例均高于后者。
根据 VCTE，超过一半的中国成年人患有 NAFLD。基于 VCTE 的筛查更有可能识别出具有严重临床特征的 NAFLD 患者，而不是超声。因此，VCTE 是中国筛查和随访 NAFLD 的一种更实用的非侵入性工具。
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