基于CT三维重建技术探讨脾脏体积与非酒精性脂肪性肝病的关系

梁肖; 董彩霞; 李国栋; 尚琪; 秦博文; 万丹; 王茜; 李路; 陈欣; 李宗芳

doi:10.12449/JCH250813

基于CT三维重建技术探讨脾脏体积与非酒精性脂肪性肝病的关系

DOI: 10.12449/JCH250813

梁肖¹,
董彩霞¹,
李国栋¹,
尚琪^{1, 2},
秦博文¹,
万丹¹,
王茜¹,
李路³,
陈欣⁴,
李宗芳^{1, 2, , ,}

1.
西安交通大学第二附属医院生物诊断治疗国家地方联合工程研究中心，西安 710004
2.
西安交通大学第二附属医院陕西省肝脾疾病临床医学研究中心，西安 710004
3.
西安交通大学第二附属医院消化内科，西安 710004
4.
西安交通大学第二附属医院医学影像科，西安 710004

基金项目:

陕西省自然科学基础研究计划项目 (2023-JC-QN-0870);

陕西省自然科学基础研究计划项目 (2023-YBSF-220);

西安交通大学第二附属医院自由探索项目 (2020YJ（ZYTS）546-07)

伦理学声明：本研究方案于2022年6月7日经由西安交通大学第二附属医院医学伦理委员会审批，批号：2022137。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：梁肖负责数据收集及分析，起草论文，参与课题设计；董彩霞、李国栋负责脾脏三维重建，体积测量；尚琪、秦博文、万丹和王茜参与数据收集和分析；陈欣负责影像数据勾勒及论文修改；李路参与论文修改；李宗芳负责课题思路，指导撰写文章并最后定稿。

详细信息

通信作者:
李宗芳， lzf2568@xjtu.edu.cn （ORCID： 0000-0003-4813-1176）

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出版历程
- 收稿日期: 2025-01-09
- 录用日期: 2025-03-14
- 出版日期: 2025-08-25

Relationship between spleen volume and non-alcoholic fatty liver disease by three-dimensional computed tomography reconstruction

Xiao LIANG¹,
Caixia DONG¹,
Guodong LI¹,
Qi SHANG^{1, 2},
Bowen QIN¹,
Dan WAN¹,
Qian WANG¹,
Lu LI³,
Xin CHEN⁴,
Zongfang LI^{1, 2
, ,
,}

1.
National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy The Second Affiliated Hospital of Xi’an Jiaotong University，Xi’an 710004，China
2.
Shaanxi Provincial Clinical Medical Research Center for Liver and Spleen Diseases The Second Affiliated Hospital of Xi’an Jiaotong University，Xi’an 710004，China
3.
Department of Gastroenterology The Second Affiliated Hospital of Xi’an Jiaotong University，Xi’an 710004，China
4.
Department of Radiology The Second Affiliated Hospital of Xi’an Jiaotong University，Xi’an 710004，China

Research funding:

The Natural Science Basic Research Project of Shaanxi Province (2023-JC-QN-0870);

The Natural Science Basic Research Project of Shaanxi Province (2023-YBSF-220);

The Project of the Second Affiliated Hospital of Xi’an Jiaotong University (2020YJ（ZYTS）546-07)

More Information

Corresponding author: LI Zongfang， lzf2568@xjtu.edu.cn （ORCID： 0000-0003-4813-1176）

摘要

摘要: 目的探讨脾脏体积与非酒精性脂肪性肝病（NAFLD）发病风险的相关性，并进一步探究脾脏体积与NAFLD的因果关系。方法选取2022年11月—2023年11月在西安交通大学第二附属医院行腹部增强CT检查的个体，包括90例NAFLD患者和47例健康对照者。采用两阶段由粗到细的图像分割方法，通过构建深度学习网络模型，对脾脏进行三维重建。计量资料两组间比较采用成组t检验或Mann-Whitney U检验；计数资料两组间比较采用χ²检验。采用Pearson相关或Spearman秩相关分析脾脏体积与肝功能指标的相关性。采用多因素Logistic回归分析NAFLD发生的影响因素。此外，进一步采用双样本孟德尔随机化（MR）探讨脾脏体积与NAFLD之间是否存在因果关联，逆方差加权法（IVW）为MR主要研究方法。结果 NAFLD患者脾脏体积显著大于健康对照者［（272.93±104.16） cm³ vs （204.37±81.20） cm³，P<0.001］。Spearman秩相关分析显示，NAFLD患者脾脏体积与肝脂肪变性指数（HIS）（r_s =0.422，P<0.001）和GGT（r_s =0.211，P=0.047）呈正相关。多因素Logistic回归模型结果显示，脾脏体积是NAFLD发生的独立危险因素（OR=1.01，95% CI：1.00～1.02，P=0.049）；IVW结果显示，脾脏体积与NAFLD存在因果关系（OR=1.16，95%CI：1.05～1.28，P=0.005）。结论脾脏体积增大可能是NAFLD发生、发展的一个危险因素，具体机制仍需进一步深入研究。
- 脾脏体积 /
- 非酒精性脂肪性肝病 /
- 成像，三维 /
- 孟德尔随机化分析
Abstract: Objective To investigate the association of spleen volume with the risk of non-alcoholic fatty liver disease （NAFLD） as well as their causal relationship. Methods We included 90 NAFLD cases and 47 healthy controls who had received contrast-enhanced computed tomography （CT） scan of the abdomen at the Second Affiliated Hospital of Xi’an Jiaotong University from November 2022 to November 2023. We conducted three-dimensional reconstruction of the spleen through a deep learning network model using a two-stage coarse-to-fine segmentation approach. We compared the two groups using the two-sample t test or Mann-Whitney U test for continuous data and using the chi-square test for categorical data； evaluated the correlation between spleen volume and liver function indicators through Pearson correlation or Spearman rank correlation analyses； determined the factors influencing the development of NAFLD through multivariable Logistic regression analysis； and further assessed the casual relationship between spleen volume and NAFLD using the inverse variance-weighted two-sample Mendelian randomization （IVW-MR） method. Results Spleen volume was significantly larger in NAFLD cases than in controls （272.93±104.16 vs 204.37±81.20 cm³， P<0.001）. The Spearman rank correlation analysis showed that spleen volume was positively correlated with the hepatic steatosis index （r_s =0.422， P<0.001） and gamma-glutamyl transferase levels （r_s =0.211， P=0.047） in patients with NAFLD. The multivariable Logistic regression analysis indicated that spleen volume was an independent risk factor for the development of NAFLD （odds ratio ［OR］=1.01， 95% confidence interval ［CI］： 1.00　—　1.02， P=0.049）. The IVW-MR analysis detected a causal relationship between spleen volume and NAFLD （OR=1.16， 95%CI： 1.05　—　1.28， P=0.005）. Conclusion Increased spleen volume may be a risk factor for the development and progression of NAFLD. Further studies are still needed to investigate the specific mechanism.
- Spleen Volume /
- Non-alcoholic Fatty Liver Disease /
- Imaging， Three-Dimensional /
- Mendelian Randomization Analysis

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图 1 脾脏三维重建示意图

Figure 1. The diagram of 3D reconstruction of spleen

下载: 全尺寸图片幻灯片

图 2 脾脏体积与NAFLD发病风险的散点图

Figure 2. Scatterplot for the association of spleen volume on risk of NAFLD

下载: 全尺寸图片幻灯片

图 3 脾脏体积对NAFLD影响效应的森林图

Figure 3. Forest plot of effect size for spleen volume on NAFLD

下载: 全尺寸图片幻灯片

图 4 留一法分析森林图

Figure 4. Forest plot of leave-one-out analysis

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表 1 NAFLD组和健康对照组基线及临床特征比较

Table 1. Baseline demographic and clinical characteristics between NAFLD patients and controls

指标	NAFLD组（n=90）	健康对照组（n=47）	统计值	P值
脾脏体积（cm³）	272.93±104.16	204.37±81.20	t=-3.929	<0.001
年龄（岁）	47.34±12.42	55.51±14.21	t=3.475	0.001
男［例（%）］	59（65.56）	26（55.32）	χ²=1.374	0.241
BMI（kg/m²）	26.71±3.44	23.59±2.69	t=-4.208	0.005
HSI	37.29（34.50～41.29）	30.88（28.92～33.19）	Z=-5.265	<0.001
eGFR（mL·min^-1·1.73m^-²）	108.09（95.31～114.71）	107.73（98.30～115.69）	Z=-0.467	0.641
血脂异常［例（%）］	67（74.44）	18（38.30）	χ²=17.131	<0.001
ALT（U/L）	34.00（22.50～45.00）	16.00（12.00～22.40）	Z=-6.264	<0.001
AST（U/L）	27.00（21.50～36.50）	20.00（16.00～26.00）	Z=-3.950	<0.001
GGT（U/L）	39.00（27.50～74.50）	18.00（14.00～25.00）	Z=-6.300	<0.001
ALP（U/L）	81.00（67.50～93.00）	70.00（60.00～96.00）	Z=-1.321	0.187
TP（g/L）	70.20±5.82	68.08±6.82	t=-1.908	0.059
Alb（g/L）	44.32±4.21	41.79±4.58	t=-3.238	0.002
Glb（g/L）	25.88±3.87	26.29±4.09	t=0.575	0.566
A/G	1.75±0.29	1.62±0.27	t=-2.487	0.014

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表 2 脾脏体积与肝功能指标的相关性分析

Table 2. Correlations of spleen volume with indicators of liver function

指标	总人群（n=137）		NALFD组（n=90）		健康对照组（n=47）
指标	相关系数	P值	相关系数	P值	相关系数	P值
HSI	0.338	0.001	0.422	<0.001	-0.138	0.501
ALT（U/L）	0.206	0.016	0.198	0.063	-0.087	0.560
AST（U/L）	0.066	0.445	0.058	0.592	-0.284	0.053
GGT（U/L）	0.226	0.008	0.211	0.047	-0.135	0.364
ALP（U/L）	0.139	0.107	0.104	0.334	0.070	0.638
TP（g/L）	0.103	0.231	0.027	0.801	0.115	0.441
Alb（g/L）	0.118	0.172	0.022	0.835	0.061	0.686
Glb（g/L）	0.029	0.734	0.016	0.880	0.124	0.407
A/G	0.064	0.462	0.034	0.755	-0.105	0.483

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表 3 Logistic回归分析NAFLD的影响因素

Table 3. Logistic regression analysis of influencing factors for NAFLD

变量	单因素Logistic回归分析		多因素Logistic回归分析
变量	OR（95%CI）	P值	OR（95%CI）	P值
脾脏体积（cm³）	1.01（1.00～1.01）	<0.001	1.01（1.00～1.02）	0.049
年龄（岁）	0.95（0.93～0.98）	0.001	0.99（0.94～1.04）	0.693
性别（0=男；1=女）	1.54（0.75～3.16）	0.242
BMI（kg/m²）	1.37（1.16～1.62）	<0.001	0.69（0.43～1.09）	0.112
HSI	1.34（1.17～1.53）	<0.001	1.59（1.05～2.40）	0.028
血脂异常（0=否；1=是）	8.80（3.66～21.13）	<0.001	3.98（1.34～11.86）	0.013
eGFR（mL·min^-1·1.73 m^-²）	0.99（0.97～1.01）	0.479
ALT（U/L）	1.10（1.05～1.14）	<0.001	0.99（0.89～1.10）	0.826
AST（U/L）	1.08（1.04～1.14）	0.001	1.09（0.97～1.23）	0.133
GGT（U/L）	1.01（1.00～1.02）	0.088
ALP（U/L）	1.00（0.99～1.01）	0.619
TP（g/L）	1.06（0.98～1.12）	0.061
Alb（g/L）	1.14（1.05～1.25）	0.003	1.03（0.90～1.17）	0.668
Glb（g/L）	0.97（0.89～1.07）	0.564
A/G	5.13（1.35～19.47）	0.016	7.40（0.75～72.63）	0.086

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表 4 脾脏体积与NAFLD的MR结果

Table 4. The association between spleen volume and NAFLD by MR

MR方法	SNP	OR（95%CI）	P值
加权模式	53	1.14（0.94～1.38）	0.194
加权中位数法	53	1.10（0.93～1.30）	0.269
简单模式	53	1.17（0.85～1.61）	0.338
MR-Egger	53	1.14（0.90～1.45）	0.294
IVW	53	1.16（1.05～1.28）	0.005

注：暴露变量，脾脏体积；结局变量，NAFLD。

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