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Objective To investigate the application value of controlled attenuation parameter (CAP) of hepatocyte steatosis measured by FibroScan in the diagnosis and traditional Chinese medicine (TCM) syndrome differentiation of nonalcoholic fatty liver disease (NAFLD). Methods A retrospective analysis was performed for related data of 364 patients with NAFLD who attended The First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2017 to December 2019, including basic information (age, sex, and body mass index [BMI]), CAP measured by FibroScan, ultrasound findings of the liver, gallbladder, spleen, and pancreas, liver function parameters, and blood lipid parameters. TCM syndrome differentiation was performed based on the information obtained by four diagnostic methods, and then the patients were divided into liver depression and spleen deficiency group, damp turbidity and stagnation group, damp-heat accumulation group, intermingled phlegm and blood stasis group, and spleen-kidney deficiency group. The association of CAP, color Doppler ultrasound findings, liver function parameters, blood lipid parameters, and BMI with TCM syndrome was analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups; the Kruskal-Wallis H rank sum test with multiple sets of independent samples was used for comparison of non-normally distributed continuous data between multiple groups and further comparison between two groups. The chi-square test or Kruskal-Wallis H rank sum test was used for comparison of categorical data between multiple groups and further comparison between two groups. A Spearman's rank correlation analysis was used to investigate the correlation between CAP and ultrasound grading. Results Among the 364 patients with NAFLD, 169 had the syndrome of liver depression and spleen deficiency, 71 had the syndrome of damp turbidity and stagnation, 60 had the syndrome of damp-heat accumulation, 41 had the syndrome of intermingled phlegm and blood stasis, and 23 had the syndrome of spleen-kidney deficiency. There was a significant difference in CAP value between the different syndrome types ( F =14.839, P < 0.001), and further comparison between two groups showed that the spleen-kidney deficiency group and the intermingled phlegm and blood stasis group had a significantly higher CAP value than the liver depression and spleen deficiency group, the damp turbidity and stagnation group, and the damp-heat accumulation group (all P < 0.05). There was a significant difference in ultrasound grading between the different syndrome types ( χ 2 =22.947, P < 0.001); the liver depression and spleen deficiency group mainly had a mild grade (40.2%), the damp turbidity and stagnation group and the damp-heat accumulation group mainly had a moderate grade (53.5% and 53.3%, respectively), and the intermingled phlegm and blood stasis group and the spleen-kidney deficiency group mainly had a severe grade (68.3% and 43.5%, respectively). CAP was positively correlated with the severity of fatty liver ( r =0.431, P < 0.001). The spleen-kidney deficiency group and the intermingled phlegm and blood stasis group had significantly higher levels of alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, and BMI than the other three groups (all P < 0.001). Conclusion Association is observed between CAP and the TCM syndrome types of NAFLD, and patients with the syndrome of spleen-kidney deficiency and the syndrome of intermingled phlegm and blood stasis have a higher CAP value than those with the other syndrome types. CAP has similar efficiency to color Doppler ultrasound in the diagnosis of NAFLD.
ABSTRACT
Objective@#To explore the relationship between liver controlled attenuation parameters (CAP) and body fat mass and its distribution.@*Methods@#From May to December 2018, 978 adult patients visited at the fatty liver center of the Third People's Hospital of Changzhou were treated. The patient's liver controlled attenuation parameters were measured by transient elastography and the body fat mass and its distribution were measured by bioelectrical impedance technology. Pearson’s correlation coefficient was adopted to describe the correlation between liver CAP value and body mass index (BMI), body fat mass index (BFMI), trunk fat mass index (TFMI), limbs fat mass index (LFMI) and visceral fat area (VFA). Receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate BMI, BFMI, TFMI, LFMI and VFA to differentiate the cut-off points and efficacy of CAP for diagnosing grading of fatty liver changes in S0-1 and S2-3.@*Results@#In 653 cases of male, S0 ~ S3 accounted for 4.90%, 3.37%, 22.36% and 69.37%, respectively, and in 325 cases of females, S0 ~ S3 accounted for 7.38%, 6.46%, 13.23% and 72.92%, respectively. Female patients had more visceral, trunk and limbs fat than male (P < 0.01). Body mass, body fat mass, body fat percentage, BMI, BFMI, TFMI, LFMI, and VFA were increased in male and female patients with increasing liver fat grade (P < 0.01). CAP values of male and female patients were positively correlated with BMI, BFMI, TFMI, LFMI and VFA. Percentage of body fat mass increased with increasing liver fat grade (male: F = 13.42, P < 0.001; female: F = 3.22, P = 0.023); while limb fat mass percentage did not increase with liver fat grade (Male: F = 1.13, P = 0.34; female: F = 1.05, P = 0.37). Hepatic steatosis grading (S0 ~ 1 or S2 ~ 3) diagnosed with CAP were distinguished through BMI, BFMI, TFMI, LFMI and VFA. AUC was 0.80 ~ 0.82 in males (P < 0.01), and 0.75 ~ 0.78 in females (P < 0.01).@*Conclusion@#The liver CAP value is positively correlated with the body's limbs, trunk and visceral fat, and has a strong correlation with trunk and visceral fat. BMI, BFMI, TFMI, LFMI and VFA up to some extent can identify the CAP diagnosis of grading of fatty liver changes in S0-1 and S2-3.
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ObjectiveTo investigate the incidence and possible related factors for fatty liver among workers engaged in light manual labor in Tianjin, China. MethodsAmong 800 healthy workers engaged in light manual labor randomly selected from a company in Tianjin, a total of 602 healthy workers completed physical examination and data collection. The content of fat and liver stiffness were determined by controlled attenuation parameter (CAP) using FibroScan, and the disease history, body mass, height, blood pressure, and living habits in all subjects were investigated. The possible related factors for different degrees of fatty liver were analyzed. Between-group comparison of continuous data was performed using the Kruskal-Wallis H test, and comparison of categorical data was performed using χ2 test with row×column tables. Pairwise comparison was performed using χ2 segmentation method, and the agreement between CAP and color ultrasound was analyzed using the Kappa coefficient. ResultsAmong the 602 subjects, there were 180 (29.9%), 195 (32.3%), and 227 (37.7%) subjects with severe fatty liver, moderate fatty liver, and no fatty liver, respectively. There were significant differences in age, body mass index, waist-hip ratio, smoking, drinking, history of diabetes, and family history between the above three groups according to CAP (P＜005 for all). With higher sensitivity, CAP achieved a significantly higher detection rate of fatty liver than traditional color ultrasound (623% vs 44.0%, P=0.000). The agreement between two methods was poor (Kappa value ＜0.4). ConclusionAmong the so-called “healthy people” engaged in light manual labor, the incidence of fatty liver has exceeded 60%, which is associated with body mass index, waist-hip ratio, bad living habits, history of diabetes, and family history of fatty liver. CAP can noninvasively detect fatty liver with higher sensitivity and less time; however, its clinical significance needs further studies.