To Explore The Correlation Between NAFLD Ultrasonic Image And Its TCM Syndrome Types Based On ATI Technique

Objective:To explore the correlation between TCM syndrome types and its ultrasonic images of non-alcoholic fatty liver disease based on ATI technology,to evaluate the diagnostic value of ATI attenuation coefficient for NAFLD,to provide an objective reference basis for TCM syndrome differentiation of NAFLD,to provide a new technique for the clinical diagnosis of NAFLD.Methods:150 NAFLD patients with NAFLD who attended our ultrasound medicine department between October 01,2021 and April 01,2022 were selected for the study.The general conditions(gender,age,BMI,blood lipids),the four diagnoses of traditional Chinese medicine and ultrasonic imaging(2D gray-scale ultrasound grading,ATI attenuation coefficient)information were collected,and the syndrome differentiation of NAFLD patients was carried out according to the information of four diagnosis of traditional Chinese medicine.They were divided into five groups:liver depression and spleen deficiency syndrome,dampness-turbid internal stagnation syndrome,dampness-heat accumulation syndrome,phlegm and blood stasis syndrome,spleen-kidney deficiency syndrome.Another50 healthy adults were selected as the control group.The above information was collated and statistically analyzed using SPSS 26.0 statistical software and Medcalc 18.2.1 software.Results:1.The distribution of gender and age among different TCM syndrome types of NAFLD was not statistically significant(P>0.05),and the difference of BMI value was statistically significant(F=2.748,P<0.05);the difference of TG value and TC value among TCM syndrome types was statistically significant(F=6.491 and 24.788,P<0.001);the difference of HDL value and LDL value among TCM syndrome types was no statistically significant(P>0.05).2.There was a significant difference in the distribution of 2D gray-scale ultrasound grading among the TCM syndrome types of NAFLD(χ~2=25.415,P<0.001).Liver-depression and spleen-deficiency syndrome were mostly manifested as mild fatty liver;dampness and internal stagnation syndrome and damp-heat accumulation syndrome were mostly manifested as moderate fatty liver;and phlegm-stasis interconnection syndrome and spleen-kidney deficiency syndrome were mostly manifested as severe fatty liver.3.The differences in ATI attenuation coefficients between different ultrasound classifications in NAFLD patients were statistically significant(F=50.828,P<0.001),and the attenuation coefficients gradually increased with the increase in the degree of fatty liver;the ATI attenuation coefficient was positively correlated with ultrasound classification(r=0.766,P<0.001).For the diagnosis of mild fatty liver(≥S1),the area under the ROC curve and the cut-off value were 0.933 and 0.625 d B/cm/MHz,respectively;for the diagnosis of moderate fatty liver(≥S2),the area under the ROC curve and the cut-off value were 0.951 and 0.715d B/cm/MHz,respectively;for the diagnosis of severe fatty liver(S3),the area under the ROC curve and the cut-off value were 0.916 and 0.870 d B/cm/MHz,respectively.The area and cut-off values were 0.916 and 0.870 d B/cm/MHz,respectively.4.There was a significant difference(F=25.168,P<0.001)in ATI attenuation coefficient among different TCM syndrome types of NAFLD.The attenuation coefficient of phlegm-stasis interconnection syndrome was the highest(0.81±0.12d B/cm/MHz).Followed by spleen and kidney deficiency syndrome,damp-heat accumulation syndrome,dampness-turbidity internal stop syndrome,liver depression and spleen deficiency syndrome.5.When 0.645 d B/cm/MHz was used as the threshold value to distinguish the liver depression and spleen deficiency syndrome from other syndrome types,the area under the ROC curve was 0.808(P<0.001),and the sensitivity and specificity were 89.19%and60.00%,respectively.6.There was a correlation(P<0.05)between ATI attenuation coefficient and BMI value(r=0.425)and TC value(r=0.205),and no correlation with TG values(P>0.05).Conclusion:1.Ultrasound ATI technique can quantitatively detect liver steatosis in patients with NAFLD and has a high diagnostic value for grading hepatic steatosis.2.There is a correlation between the TCM syndrome types of NAFLD and ATI attenuation coefficients,and the assessment of ATI attenuation coefficients is helpful for TCM diagnosis and treatment of NAFLD with liver depression and spleen deficiency syndrome,which will provide a new non-invasive and objective index for TCM evidence-based treatment.3.There were correlations between NAFLD TCM syndrome type and BMI,TG and TC values,but not with gender and age;there was a positive correlations between ATI attenuation coefficient and BMI and TC,but not with TG.