Study on the Predictive Value of Abdominal Fat Content and Distribution in the Acute Pancreatitis and Its Severity

doi:10.12114/j.issn.1007-9572.2022.0735

Abstract

Abstract:

Background

Acute pancreatitis (AP) is a common acute abdominal abdomen, and severe AP has considerable mortality. Early and accurate identification of AP is critical for the prevention, treatment and prognosis evaluation of AP. Studies have shown that obesity is associated with the incidence and clinical outcome of AP. However, there is a lack of obesity-related quantitative indices for the diagnosis and evaluation of AP.

Objective

To investigate the relationship of abdominal fat content and distribution with AP and its severity, providing a scientific basis for the prevention, diagnosis and treatment of AP.

Methods

One hundred AP patients (including 75 with non-severe AP and 25 with severe AP) and 100 non-AP patients〔AP was diagnosed by Chinese Guidelines for the Management of Acute Pancreatitis (Shenyang, 2019) 〕were selected from Department of General Surgery, the Southwest Hospital of AMU from January 2019 to June 2021. Clinical data were collected, including sex, age, underlying disease (hypertension, diabetes or hyperlipidemia) , history of biliary tract disease, BMI, areas of CT-assessed abdominal subcutaneous adipose tissue (SAT) , visceral adipose tissue (VAT) and total abdominal adipose tissue (TAT) , and calculated VAT/SAT ratio and VAT/TAT ratio. Multivariate Logistic regression analysis was conducted to identify factors associated with AP and its severity. ROC analysis was conducted to estimate the diagnostic value and efficiency of BMI, and indices related to abdominal fat content and distribution for the prevalence and severity of AP.

Results

The proportion of BMI and hyperlipidemia in AP group was higher than that in non-AP group (P<0.05) . VAT, TAT, VAT/SAT and VAT/TAT in AP group were higher than those in non-AP group (P<0.05) . VAT, TAT, VAT/SAT and VAT/TAT in severe AP subgroup were higher than those in non-severe AP subgroup (P<0.05) . Multivariate Logistic analysis showed that BMI〔OR=1.985, 95%CI (1.616, 2.438) 〕, VAT〔OR=1.126, 95%CI (1.088, 1.165) 〕, TAT〔OR=1.028, 95%CI (1.019, 1.038) 〕 were associated with AP (P<0.05) . BMI〔OR=7.543, 95%CI (2.576, 22.088) 〕and TAT〔OR=1.074, 95%CI (1.038, 1.111) 〕were associated with the severity of AP (P<0.05) . For predicting AP, the AUC of BMI was 0.833〔95%CI (0.777, 0.888) , P<0.001〕, with 90.0% sensitivity and 62.0% specificity when the optimal cut-off value was chosen as 17.610 kg/m²; the AUC of VAT was 0.939〔95%CI (0.909, 0.969) , P<0.001〕, with 84.0% sensitivity and 89.0% specificity when the optimal cut-off value was chosen as 104.250 cm²; the AUC of TAT was 0.800〔95%CI (0.739, 0.860) , P<0.001〕, with 83.0% sensitivity and 66.0% specificity when the optimal cut-off value was chosen as 184.995 cm². When it comes to predicting the severity of AP, the AUC of TAT was 0.910〔95%CI (0.844, 0.976) , P<0.001〕, with 84.0% sensitivity and 84.0% specificity when the optimal cut-off value was chosen as 201.357 cm², and the AUC of BMI was 0.928〔95%CI (0.856, 1.000) , P<0.001〕, with 88.0% sensitivity and 89.3% specificity when the optimal cut-off value was chosen as 21.180 kg/m².

Conclusion

CT-assessed abdominal fat content and distribution may be closely associated with AP and its severity. It is suggested to include CT quantitative measurement of abdominal fat content and distribution in the AP diagnosis, severity assessment and treatment system since the two indicators reflect relevant information that could be used as scientific evidence.

Key words: Pancreatitis, Acute pancreatitis, Computed tomography, Subcutaneous adipose tissue, Viscera adipose tissue, Diagnosis, Prediction

摘要：

背景

急性胰腺炎（AP）是临床常见急腹症，重症AP病死率较高。早期准确识别对其防治及预后评估有重要意义。研究表明肥胖影响AP发病及临床结局，但目前缺乏诊断和评估AP的相关定量体脂指标。

目的

探讨腹部脂肪含量和分布与AP及其严重程度的关系，为预防、诊治AP提供科学依据。

方法

选择2019年1月—2021年6月在陆军军医大学西南医院普外科住院并行腹部CT检查的患者200例为研究对象，将患者分为AP组（n=100）与非AP组（n=100），同时按照AP的严重程度将AP组分为非重症AP亚组（n=75）和重症AP亚组（n=25）。收集研究对象的性别、年龄、基础疾病（高血压、糖尿病、高脂血症）、胆管疾病史、BMI等临床资料，并测量患者皮下脂肪组织（SAT）及内脏脂肪组织（VAT）面积，计算腹部总脂肪组织（TAT）面积、VAT与SAT面积之比（VAT/SAT）、VAT与TAT面积之比（VAT/TAT）。采用多因素Logistic回归分析探究AP患病和严重程度的影响因素，采用受试者工作特征曲线（ROC曲线）评价BMI、腹部脂肪含量与分布指标对AP患病和严重程度的预测价值。

结果

AP组患者BMI、高脂血症占比高于非AP组（P<0.05）；AP组患者VAT面积、TAT面积、VAT/SAT、VAT/TAT高于非AP组（P<0.05）。重症AP亚组患者VAT面积、TAT面积、VAT/SAT、VAT/TAT高于非重症AP亚组（P<0.05）。多因素Logistic回归分析结果显示，BMI〔OR=1.985，95%CI（1.616，2.438）〕、VAT面积〔OR=1.126，95%CI（1.088，1.165）〕、TAT面积〔OR=1.028，95%CI（1.019，1.038）〕为AP的影响因素（P<0.05）；BMI〔OR=7.543，95%CI（2.576，22.088）〕、TAT面积〔OR=1.074，95%CI（1.038，1.111）〕是AP严重程度的影响因素（P<0.05）。BMI预测AP的ROC曲线下面积（AUC）为0.833〔95%CI（0.777，0.888），P<0.001〕，最佳截断值为17.610 kg/m²，灵敏度为90.0%，特异度为62.0%；VAT面积预测AP的AUC为0.939〔95%CI（0.909，0.969），P<0.001〕，最佳截断值为104.250 cm²，灵敏度为84.0%，特异度为89.0%；TAT面积预测AP的AUC为0.800〔95%CI（0.739，0.860），P<0.001〕，最佳截断值为184.995 cm²，灵敏度为83.0%，特异度为66.0%。TAT面积预测AP严重程度的AUC为0.910〔95%CI（0.844，0.976），P<0.001〕，最佳截断值为201.357 cm²，灵敏度为84.0%，特异度为84.0%；BMI预测AP严重程度的AUC为0.928〔95%CI（0.856，1.000），P<0.001〕，最佳截断值为21.180 kg/m²，灵敏度为88.0%，特异度为89.3%。

结论

腹部脂肪含量及分布与AP的发生及严重程度之间存在密切关系。基于CT定量检查腹部脂肪含量及分布可为诊断AP及预测重症AP提供重要参考信息，未来可考虑纳入诊断、评估AP及重症AP的评价系统，为预防、诊治AP提供科学依据。

关键词: 胰腺炎, 急性胰腺炎, 计算机断层扫描, 皮下脂肪组织, 内脏脂肪组织, 诊断, 预测

HU Xiaofei,ZHAO Ping,CAO Tinghua, et al. Study on the Predictive Value of Abdominal Fat Content and Distribution in the Acute Pancreatitis and Its Severity[J]. Chinese General Practice, 2023, 26(21): 2614-2619. DOI: 10.12114/j.issn.1007-9572.2022.0735.
胡晓飞,赵平,曹廷华等. 腹部脂肪含量及分布对急性胰腺炎及其重症的预测价值研究[J]. 中国全科医学, 2023, 26(21): 2614-2619. DOI: 10.12114/j.issn.1007-9572.2022.0735.

Figures/Tables 8

References 23

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组别	例数	年龄（±s，岁）	性别（男/女）	高血压〔n（%）〕	糖尿病〔n（%）〕	高脂血症〔n（%）〕	胆管疾病史〔n（%）〕	BMI （±s，kg/m²）
AP组	100	45.4±15.3	76/24	29（29.0）	21（21.0）	43（43.0）	23（23.0）	26.3±3.1
非AP组	100	43.2±13.5	68/32	26（26.0）	19（19.0）	25（25.0）	17（17.0）	23.6±2.2
χ²（t）值		1.267^a	1.587	0.226	0.125	7.219	1.125	9.754^a
P值		0.205	0.208	0.635	0.724	0.007	0.289	<0.001

组别	例数	年龄（±s，岁）	性别（男/女）	高血压〔n（%）〕	糖尿病〔n（%）〕	高脂血症〔n（%）〕	胆管疾病史〔n（%）〕	BMI （±s，kg/m²）
AP组	100	45.4±15.3	76/24	29（29.0）	21（21.0）	43（43.0）	23（23.0）	26.3±3.1
非AP组	100	43.2±13.5	68/32	26（26.0）	19（19.0）	25（25.0）	17（17.0）	23.6±2.2
χ²（t）值		1.267^a	1.587	0.226	0.125	7.219	1.125	9.754^a
P值		0.205	0.208	0.635	0.724	0.007	0.289	<0.001

组别	例数	SAT面积（cm²）	VAT面积（cm²）	TAT面积（cm²）	VAT/SAT	VAT/TAT
AP组	100	125.33±23.18	205.20±18.88	330.54±41.86	1.68±0.27	0.62±0.03
非AP组	100	119.90±20.20	160.40±22.23	280.30±42.27	1.34±0.05	0.57±0.01
t值		1.767	15.362	8.445	12.292	17.592
P值		0.079	<0.001	<0.001	<0.001	<0.001

组别	例数	SAT面积（cm²）	VAT面积（cm²）	TAT面积（cm²）	VAT/SAT	VAT/TAT
AP组	100	125.33±23.18	205.20±18.88	330.54±41.86	1.68±0.27	0.62±0.03
非AP组	100	119.90±20.20	160.40±22.23	280.30±42.27	1.34±0.05	0.57±0.01
t值		1.767	15.362	8.445	12.292	17.592
P值		0.079	<0.001	<0.001	<0.001	<0.001

组别	例数	SAT面积（cm²）	VAT面积（cm²）	TAT面积（cm²）	VAT/SAT	VAT/TAT
非重症AP亚组	75	126.53±17.82	178.74±20.51	305.26±37.77	1.42±0.09	0.59±0.01
重症AP亚组	25	130.59±15.48	243.39±18.76	373.98±34.01	1.87±0.10	0.65±0.01
t值		-1.019	-13.932	-8.068	-21.677	-21.108
P值		0.311	<0.001	<0.001	<0.001	<0.001