Prevalence and Risk Factors of Focal Sparing in Hepatic Steatosis

Zusammenfassung

Ziel: Prävalenz, Lokalisation und mögliche Risikofaktoren einer fokalen Minderverfettung wurden bei Probanden mit einer sonografisch nachweisbaren Steatosis hepatis im Rahmen einer bevölkerungsbasierten Querschnittsstudie prospektiv untersucht. Material und Methoden: Insgesamt wurden 1624 Probanden (n = 906 Frauen; n = 718 Männer) sonografisch, laborchemisch und mittels Fragenbogen untersucht (Philips HDI 5000). Probanden mit einem Alkoholkonsum > 40 g/die bei Männern und > 20 g/die bei Frauen mit einer chronischen Hepatitis B und C, erhöhten Transaminasen (AST, ALT) und Zustand nach Nephrektomie rechts wurden aus der Auswertung ausgeschlossen. Ergebnisse: Die Prävalenz einer fokalen Minderverfettung bei Steatosis hepatis Grad I betrug 25,6 % für Männer und 13,0 % für Frauen, bei einer Steatosis hepatis Grad II/III 70,9 % für Männer und 77,6 % für Frauen. Die häufigste Lokalisation einer fokalen Minderverfettung war Segment IV der Leber. Die durchschnittliche Größe betrug 22,3 mm (Range 7 – 84 mm). Für die untersuchten Risikofaktoren „Alter” (p = 0,09) und „Zustand nach Cholezystektomie” (p = 0,09) konnte kein Zusammenhang nachgewiesen werden. Männliches Geschlecht (p = 0,02) und ein metabolisches Syndrom (Odds Ratio, 2,1; 95 %-Konfidenzinterval, 1,1 – 4,1; p = 0,02) konnten als Risikofaktoren bestätigt werden. Schlussfolgerung: Der sonografische Nachweis einer fokalen Minderverfettung bei Probanden mit einer Steatosis hepatis ist mit einem erhöhten Risiko für ein metabolisches Syndrom vergesellschaftet und stellt möglicherweise somit ein einfaches diagnostisches Kriterium zur Selektion von Risikopatienten in der täglichen Routine dar.

Abstract

Purpose: The prevalence, localization and potential risk factors for focal sparing were prospectively assessed in subjects with sonographically detectable hepatic steatosis as part of a population-based cross-sectional study. Materials and Methods: A total of 1,624 persons (n = 906 women; n = 718 men) were evaluated using ultrasonography, laboratory testing and a standardized questionnaire. The following were excluded from the analysis: subjects with reported alcohol consumption > 40 g/day (males) or > 20 g/day (females), those with known chronic hepatitis B or C infection, elevated serum transaminases (AST: m > 44 U/l, f > 33 U/l; ALT: m > 45 U/l, f > 35 U/l) and prior right nephrectomy. Results: The prevalence of focal sparing in patients with hepatic steatosis (grade I) was 25.6 % for men and 13.0 % for women. In patients with grade II/III disease, the prevalence was 70.9 % for men and 77.6 % for women. The most common site of focal sparing was in segment IV. The average diameter was 22.3 mm (range 7 – 84 mm). No correlation was found for postulated risk ”age” (p = 0.09) or ”status post cholecystectomy” (p = 0.09). Male sex (p = 0.02) and metabolic syndrome (odds ratio, 2.1; 95 % confidence interval, 1.1 – 4.1; p = 0.02) were confirmed as risk factors. Conclusion: Sonographic evidence of focal sparing in subjects with hepatic steatosis is associated with an increased risk for metabolic syndrome and may be an easily obtained diagnostic criterion in routine clinical settings.

ultrasound - screening - focal sparing - liver - hepatic steatosis

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