| PurposeThis article aims to explore the clinical influencing factors of fatty deposition in the pancreas and liver and study the effectiveness of new clinical techniques for their diagnosis.The first part uses endoscopic ultrasonography(EUS)to visually determine whether there is fat deposition in the pancreas,so as to evaluate the feasibility and efficacy of quantitative computed tomography(QCT)technology to quantify pancreatic fat content(PFC),and explore the relevant clinical risk factors of pancreatic ectopic fat deposition.Provides value for clinical diagnostics.The second part is to use CT to diagnose non-alcoholic fatty liver disease(NAFLD)as the standard,measure liver fat content(LFC)by quantitative CT,evaluate the application value of quantitative CT technology in the diagnosis and degree of non-alcoholic fatty liver disease,verify its accuracy,and provide reference for the diagnosis and treatment of the disease.Method and ContentA total of 50 inpatients who underwent EUS examination and QCT scan in the Department of Gastroenterology of Wuhan Fourth Hospital from December2021～December 2022 were collected.An ultrasound endoscopist with more than five years of experience scanned the pancreas to determine whether there was a fatty pancreas,divided into fatty pancreas group and non-fat pancreas group,compared the clinical characteristics of the two groups of study subjects,and analyzed the independent related factors of fatty pancreas.After measuring by QCT method,the pancreas head,body and tail were measured separately at the software workstation,and the average value was taken as the final pancreatic density measurement.Then,the equivalent density of the pancreas is calculated and substituted into the correction formula for calculation,the QCT measurement is converted into pancreatic fat content,and the optimal threshold for QCT diagnosis of fatty pancreas is evaluated.One week later,the intragroup correlation coefficient(ICC)was used to evaluate the repeatability of measuring pancreatic fat content one week apart by the same observer.At the same time,91 patients with NAFLD and non-fatty liver patients who underwent QCT testing in our hospital were included.The bone density value of T11-L2 level was selected,the liver fat content was measured in three regions of interest in the liver,and different degrees of fatty liver were defined by the liver/spleen CT density ratio.Subgroup analysis was carried out for the indicators with significant differences between the case group and the control group,and the consistency of QCT and CT diagnosis was analyzed by Kappa consistency test.The working characteristic curve of the subjects was constructed,the area under the curve was calculated,and the diagnostic efficacy and threshold of QCT parameters,namely liver fat content,were determined.Result1.There were statistically significant differences in age,BMI,FPG,TG,LFC,PFC,VFA,obesity,metabolic syndrome,and non-alcoholic fatty liver between the fatty pancreas and non-lipid pancreas groups(p < 0.05).2.Met S patients in fatty pancreas population was 57.1 %(16/28),the proportion of non-fat pancreas group was 22.7 %(5/22),the incidence of Met S in fatty pancreas population was significantly higher(p=0.014).The proportion of patients with non-alcoholic fatty liver in the fatty pancreas group was 60.7 %,about twice that of the non-lipid pancreas group,and the difference was statistically significant(p< 0.05).3.PFC and age(r =0.298),BMI(r =0.363),FPG(r =0.233),TG(r =0.337),LFC(r =0.204),VFA(r =0.411),WC(r = 0.319)showed different degrees of positive correlation,and the correlation was statistically significant(P < 0.05).old age,obesity(general and/or central),hyperlipidemia and fatty liver are independent risk factors for fatty pancreas.4.The area under the curve of PFC for the diagnosis of fatty pancreas is 0.812;the optimal threshold value of QCT for diagnosis of fatty pancreas is 5.85%,at this time the sensitivity is 82.1%,and the specificity is 72.7%.5.There were statistically significant differences between the case group and the control group in terms of BMI,FPG,ALT,UA levels,visceral fat area(VFA),liver fat content,presence of hyperlipidemia,and metabolic syndrome(P< 0.05).But there was no significant difference in gender,age,AST,GGT,BMD,SFA between the two groups.BMI,FAT,and VFA of patients in the mild group,moderate group,and severe group increased sequentially and the difference was statistically significant(P<0.05).6.The results of QCT and CT in the diagnosis of nonalcoholic fatty liver disease were well consistent(Kappa coefficient of 0.71,P<0.05),and the cut-off points of QCT for the diagnosis of mild,moderate and severe liver fatty disease were 7.75%,15.20% and25.5%,respectively.Conclusion1.Obesity,hyperlipidaemia,and increased visceral fat are independent risk factors for ectopic fat deposition in the pancreas and liver2.The optimal threshold for the diagnosis of fatty pancreas by QCT parameters was5.85%,and the cut-off points for the diagnosis of mild,moderate and severe fatty liver were7.75%,15.20% and 25.5%,respectively.3.QCT can be used as a reliable method for the diagnosis of ectopic deposition of the pancreas and liver,and further exploration of more convenient methods for diagnosing fatty pancreas is needed... |
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