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Correlation between fibroscan and laboratory tests in non-alcoholic fatty liver disease/non-alcoholic steatohepatitis patients for assessing liver fibrosis

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World Journal of Hepatology 2022年第4期14卷 744-753页

作者： Layal Al Nanaf Mohammed Hussein Kamareddine Emilie Fayad Aniqa Hussain Said Farhat Department of Radiological Science American University of Science and TechnologyFaculty of Health SciencesBeirut 1100Lebanon Department of Internal Medicine Lankenau Medical CenterPhiladelphiaPA 19131United States Department of Radiology Saint George Hospital University Medical CenterBeirut 1100Lebanon Faculty of Medicine University of New South WalesSydney 2052Australia Department of Gastroenterology Saint George Hospital University Medical CenterBeirut 1100Lebanon

BACKGROUND Non-alcoholic fatty liver disease(NAFLD) is a spectrum of disease ranging from simple steatosis to non-alcoholic steatohepatitis(NASH), through to advanced fibrosis and cirrhosis. Many patients with NAFLD remain undiagnosed and recognizing those at risk is very crucial. Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, non-invasive imaging and lab modalities are also very promising in diagnosing these diseases.AIM To explore some of these non-invasive modalities in this context and assess how they hold up in terms of making a diagnosis while avoiding an invasive procedure like a liver biopsy.METHODS This study was conducted on NAFLD/NASH patients(n = 73) who underwent fibroscan examinations at Saint George Hospital University Medical Center over 17 mo in order to assess liver fibrosis. Obtained fibroscan results were correlated to laboratory tests and calculated aspartate transaminase(AST)/alanine transaminase(ALT) ratio, AST platelet ratio index(APRI) score and Fibrosis-4 score.RESULTS A significant age difference was observed across fibrosis stages of investigated patients. The mean stiffness score was 9.48 ± 11.77 KPa. A significant negative correlation was observed between ALT, AST, Albumin, gamma-glutamyl transferase, cholesterol, LDL, HDL, triglycerides, and ALP when compared across fibrosis stages. On the other hand, a significant positive correlation was found between Bilirubin, PT INR, partial thromboplastin time, glucose, and Platelet count when compared across fibrosis stages, in addition to AST/ALT ratio, APRI, and Fib-4 scores.CONCLUSION This study showed that Ultrasound alone is not efficient in the assessment of advancement of liver disease. Furthermore, the high positive relation between AST/ALT ratio, APRI and Fib-4 scores with fibrosis stages in NAFLD patients suggests that they could be used clinically in combination with fibroscan to predict significant fibrosis and cirrhosis and to avoid liver biopsy.

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis fibroscan Cirrhosis Hepatology

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fibroscan Detection of Fatty Liver/Liver Fibrosis in 2266 Cases of Chronic Hepatitis B

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Journal of Clinical and Translational Hepatology 2020年第2期8卷 113-119页

作者： Tingshan He Jing Li Yanling Ouyang Guotao Lv Xiaofeng Ceng Zhiqiao Zhang Jianqiang Ding Department of Infectious Diseases Shunde HospitalSouthern Medical UniversityShundeGuangdongChina Department of Pathology Shunde HospitalSouthern Medical UniversityShundeGuangdongChina

Background and Aims:fibroscan is used to determine liver stiffness and controlled attenuation parameter (referred to as CAP) scores in patients, including those with chronic hepatitis B (CHB). We used fibroscan to detect the incidence of fatty liver and fibrosis in CHB patients, and to assess the correla-tion of fibroscan measurements with blood chemistry tests. Methods: CHB patients enrolled in this study were divided independently for three separate analyses (of fibrosis, cirrho-sis, and fatty liver) based on fibroscan results. Basic infor-mation, blood chemistry test results, liver fibrosis parameters, and fibroscan results were collected. T-tests and Pearson's analyses were used to analyze the correlations between fibroscan liver stiffness measurement/CAP values and liver function, blood fat, uric acid metabolite, fibrosis, and hepatitis B virus load. Results:A total of 2266 CHB pa-tients were enrolled in the study and divided into three groups:non-significant and significant fibrosis;non-cirrhosis and early cirrhosis;and non-fatty and fatty liver. Spearman's statistical analyses showed that liver stiffness measurement or CAP values correlated with sex (r=0.137), age (r=0.119), glutamic-pyruvic transaminase (r=0.082), glutamic-oxalo-acetic transaminase (r=–0.172), gamma-glutamyltransfer-ase (r=0.225), albumin (r=0.150), globulin (r=–0.107), total bilirubin (r=–0.132), direct bilirubin (r=–0.145), white blood cell count (r=0.254), hemoglobin (r=0.205), platelets (r=0.206), total cholesterol (r=0.214), high density lipopro-tein (r=–0.243), low density lipoprotein (r=0.255), apolipo-protein B (r=0.217), hyaluronic acid (r=–0.069), laminin (r=–0.188), procollagen type IV (r=–0.067)and hepatitis B viral DNA load (r=–0.216). Conclusions: fibroscan is a non-invasive device that can detect the occurrence of fatty liver or liver fibrosis in CHB patients.

关键词： fibroscan Chronic hepatitis B Fatty liver Liver fibrosis Cirrhosis

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Effect of liver inflammation on accuracy of fibroscan device in assessing liver fibrosis stage in patients with chronic hepatitis B virus infection

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World Journal of Gastroenterology 2021年第7期27卷 641-653页

作者： Ling-Ling Huang Xue-Ping Yu Ju-Lan Li Hui-Ming Lin Na-Ling Kang Jia-Ji Jiang Yue-Yong Zhu Yu-Rui Liu Da-Wu Zeng Department of Hepatology Hepatology Research InstituteThe First Affiliated HospitalFujian Medical UniversityFuzhou 350005Fujian ProvinceChina Department of Infectious Diseases The First Hospital of Quanzhou Affiliated to Fujian Medical UniversityQuanzhou 362000Fujian ProvinceChina Fujian Key Laboratory of Precision Medicine for Cancer Fujian Key Laboratory of Laboratory MedicineThe First Affiliated HospitalFujian Medical UniversityFuzhou 350005Fujian ProvinceChina

BACKGROUND Transient elastography(fibroscan)is a new and non-invasive test,which has been widely recommended by the guidelines of chronic hepatitis B virus(HBV)management for assessing hepatic fibrosis staging.However,some confounders may affect the diagnostic accuracy of the fibroscan device in fibrosis staging.AIM To evaluate the diagnostic value of the fibroscan device and the effect of hepatic inflammation on the accuracy of fibroscan in assessing the stage of liver fibrosis in patients with HBV infection.METHODS The data of 416 patients with chronic HBV infection who accepted fibroscan,liver biopsy,clinical,and biological examination were collected from two hospitals retrospectively.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic performance of fibroscan for assessing the stage of liver fibrosis.Any discordance in fibrosis staging by fibroscan and pathological scores was statistically analyzed.Logistic regression and ROC analyses were used to analyze the accuracy of fibroscan in assessing the stage of fibrosis in patients with different degrees of liver inflammation.A non-invasive model was constructed to predict the risk of misdiagnosis of fibrosis stage using fibroscan.RESULTS In the overall cohort,the optimal diagnostic values of liver stiffness measurement(LSM)using fibroscan for significant fibrosis(≥F2),severe fibrosis(≥F3),and cirrhosis(F4)were 7.3 kPa[area under the curve(AUC)=0.863],9.7 kPa(AUC=0.911),and 11.3 kPa(AUC=0.918),respectively.The rate of misdiagnosis of fibrosis stage using fibroscan was 34.1%(142/416 patients).The group of patients who showed discordance between fibrosis staging using fibroscan and pathological scores had significantly higher alanine aminotransferase and aspartate aminotransferase levels,and a higher proportion of moderate to severe hepatic inflammation,compared with the group of patients who showed concordance in fibrosis staging between the two methods.Liver inflammation activity over 2(OR=3.53)was an independent risk factor for misdia

关键词： Liver stiffness measurement Fibrosis stage Liver inflammation Hepatitis B virus fibroscan Predictive model

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Correlation between Ultrasound Aspects of Fibrosis and fibroscan Outcomes of Patients with Chronic Hepatitis B Virus

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Open Journal of Radiology 2023年第2期13卷 113-123页

作者： Bénilde Marie-Ange Tiemtore-Kambou Adjirata Koama Alice Guingane Maimouna Payété Gynette Belem Nina Astrid Ndé Ouedraogo Madina Napon Ousséni Diallo Claudine Lougue Rabiou Cisse Department of Medical Imaging and Interventional Radiology of the Teaching Hospital of Bogodogo Bogodogo Burkina Faso Training and Research Department in Health Sciences of Joseph Ki Zerbo University of Ouagadougou Ouagadougou Burkina Faso 3Department of Internal Medicine Endocrinology and Metabolic Diseases of the Teaching Hospital of Bogodogo BogodogoBurkina Faso Department of Radiology Teaching Hospital of Charles de Gaulle Ouagadougou Burkina Faso Department of Radiology Teaching Hospital of Yalgado Ouédraogo Ouagadougou Burkina Faso

Background: The assessment of liver fibrosis is an essential part of the fol-low-up of patients with chronic HBV. Ultrasound and fibroscan are two com-monly used non-invasive examinations and the purpose of this study is to as-sess the correlation between the results of these two examinations in the as-sessment of liver fibrosis. Methodology: This was a descriptive and analytical cross-sectional study with retrospective collection over a period of 30 months from January 01, 2018 to June 30, 2020 on the correlation between the ultra-sound aspects and the results of the fibroscan of patients with chronic carriers of Hepatitis B virus at the Teaching Hospital of Bogodogo and at the faith-based health center CANDAF. Results: A total of 85 patients with fibrosis were collected. The 30 - 40 age group was the most represented (41.18%), with a male predominance of 52.94%. The patients with a married life were the most represented (77.64%), the social stratum the most represented were the middle managers (32.94%). University level was predominant among educa-tion levels (45.64%). The personal history was traditional circumcision (34.12%), excision (21.18%), manicure (16.47%). The circumstances of the findings were blood donation (34.12%), screening (21.18%), fortuitous findings (16.47%). The association between echostructure and fibrosis on the fibroscan scan was significant (homogeneous hyperechoic echostructure p = 0.0028 and granular echostructure p = 0.0001). Fibrosis on scans had a significant associa-tion with liver contour (Regular contours p = 0.0009 and p = 0.0002). Fibrosis on CT scan had a significant association for the diagnosis of fibrosis on ultra-sound (p = 0.0002 for hepatic steatosis and cirrhosis and p = 0.0013 for hepat-ic dysmorphia), on the other hand, no significant association for hepatomegaly (p = 0.8883). Conclusion: Detecting the presence of fibrosis and monitoring its progression improves the management of patients with chronic liver disease. Ultrasound scans and fibroscan are complementary in

关键词： Fibrosis HBV Ultrasound fibroscan Correlation

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Transient elastography(fibroscan)in critical care:Applications and limitations

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World Journal of Meta-Analysis 2023年第7期11卷 340-350页

作者： Sahil Kataria Deven Juneja Omender Singh Department of Critical Care Medicine Holy Family HospitalNew Delhi 110025India Department of Critical Care Medicine Max Super Speciality HospitalNew Delhi 110017India

fibroscan®is a non-invasive device that assesses the‘hardness’(or stiffness)of the liver via the technique of transient elastography.Because fibrous tissue is harder than normal liver,the degree of hepatic fibrosis can be inferred from the liver hardness.This technique is increasingly being employed to diagnose liver fibrosis,even in critically ill patients.It is now being used not only for diagnosis and staging of liver cirrhosis,but also for outcome prognostication.However,the presence of several confounding factors,especially in critically ill patients,may make interpretation of these results unreliable.Through this review we aim to describe the indications and pitfalls of employing fibroscan in patients admitted to intensive care units.

关键词： fibroscan Intensive care unit Liver dysfunction Liver stiffness Transient elastography

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CEUS and fibroscan in non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

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World Journal of Hepatology 2014年第7期6卷 496-503页

作者： Sila Cocciolillo Giustino Parruti Leonardo Marzio Digestive Physiopathology Unit Gabriele d’Annunzio University Pescara Civic Hospital 65124 Pescara Italy Infectious and Tropical Diseases Unit Pescara Civic Hospital 65124 Pescara Italy

AIM: To determine intra-hepatic blood flow and liver stiffness in patients with non-alcoholic fatty liver disease(NAFLD) and non-alcoholic steatohepatitis (NASH) using contrast-enhanced ultrasound and fibroscan.METHODS: This prospective study included 15 patients with NAFLD, 17 patients with NASH and 16 healthy controls.In each patient, real-time ultrasound was used to locate the portal vein (PV) and the right liver lobe, and 5 mL of SonoVue? was then injected intravenous in a peripheral vein of the left arm over a 4-s span. Digital recording was performed for 3 min thereafter. The recording was subsequently retrieved to identify an area of interest in the PV area and in the right liver parenchyma(LP) to assess the blood flow by processing the data using dedicated software (Qontrast?, Bracco, Italy).The following parameters were evaluated: percentage of maximal contrast activity (Peak%), time to peak (TTP, s), regional blood volume (RBV, cm3), regional blood flow (RBF, cm3/s) and mean transit time (MTT, s).At 24-48 h post-injection, liver stiffness was evaluated using fibroscan and measured in kPa. The statistical evaluation was performed using Student’s t test.RESULTS: In the PV, the Peak%, RBV and RBF were significantly reduced in the NAFLD and NASH patientscompared with the controls (Peak%: NAFLD 26.3 ± 6.6,NASH 28.1 ± 7.3 vs controls 55.8 ± 9.9, P < 0.001;RBV: NAFLD 4202.3 ± 3519.7, NASH 3929.8 ± 1941.3vs controls 7473 ± 3281, P < 0.01; RBF: NAFLD 32.5± 10.8, NASH 32.7 ± 12.1 vs controls 73.1 ± 13.9, P< 0.001). The TTP in the PV was longer in both patient groups but reached statistical significance only in the NASH patients compared with the controls (NASH 79.5± 37.8 vs controls 43.2 ± 30, P < 0.01). In the LP,the Peak%, RBV and RBF were significantly reduced in the NAFLD and NASH patients compared with the controls (Peak%: NAFLD 43.2 ± 7.3, NASH 41.7 ± 7.7 vs controls 56.6 ± 6.3, P < 0.001; RBV: NAFLD 4851.5± 2009, NASH 5069.4 ± 2292.5 vs controls 6922.9 ±2461.5, P < 0.05; RBF: NAFLD 55.7 ± 10.1, NASH 54.5 ±

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Contrast-enhanced ultrasound fibroscan Hepatic blood flow Liver stiffness

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fibroscan和GUCI评分对慢乙肝纤维化的诊断价值

Fibroscan和GUCI评分对慢乙肝纤维化的诊断价值

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作者：刘玲娜宁夏医科大学

学位级别：硕士

目的评估fibroscan和GUCI评分对慢乙肝纤维化的诊断价值。方法回顾性收集2016年9月至2021年9月就诊于宁夏医科大学总医院接受肝穿刺活检的慢性乙型肝炎感染者227例,肝活检前一天或当天行fibroscan检测,记录肝脏硬度值（LSM）,通过相关... 详细信息

目的评估fibroscan和GUCI评分对慢乙肝纤维化的诊断价值。方法回顾性收集2016年9月至2021年9月就诊于宁夏医科大学总医院接受肝穿刺活检的慢性乙型肝炎感染者227例,肝活检前一天或当天行fibroscan检测,记录肝脏硬度值（LSM）,通过相关血清学指标分别计算GUCI评分、APRI评分及FIB-4指数。采用Spearman分析LSM值、GUCI评分、APRI评分及FIB-4指数与肝纤维化分期的相关性。绘制受试者工作特征曲线,评估fibroscan和GUCI评分对显著肝纤维化（S2～4）、进展期肝纤维化（S3～4）及早期肝硬化（S4）的检验效能。结果1.依患者纤维化S值升高,其PT（H=30.041）、INR（H=37.498）、AST（H=19.873）、RDW（H=34.311）、LSM值（H=70.063）、GUCI评分（H=58.063）、APRI评分（H=52.479）、FIB-4指数（H=43.281）逐渐升高,而PLT（F=19.064）逐渐降低,差异均有统计学意义（P0.05）。2.Spearman相关性分析:AST、GGT、INR、IV-C、HA与肝纤维化程度呈正相关（P0.05）,r值分别为0.052、0.113、0.104。LSM、GUCI评分、APRI评分、FIB-4指数与肝纤维化程度呈正相关（Pfibroscan诊断纤维化效能最优;血清学模型中,GUCI评分诊断效能优于APRI评分和FIB-4指数。4.在≥S2、≥S3及S4组患者中,LSM值分别联合GUCI评分、APRI评分、FIB-4指数较LSM单独诊断时的诊断效能差异均无统计学意义（P>0.05）,但可以提高诊断灵敏度。结论fibroscan和GUCI评分值对慢乙肝纤维化呈一致性评价,具有一定的诊断价值。

关键词：慢乙肝纤维化 fibroscan GUCI评分

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Non-invasive tests of non-alcoholic fatty liver disease

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Chinese Medical Journal 2022年第5期135卷 532-546页

作者： Guanlin Li Xinrong Zhang Huapeng Lin Lilian Yan Liang Grace Lai-Hung Wong Vincent Wai-Sun Wong Department of Medicine and Therapeutics The Chinese University of Hong KongHong KongChina State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Medical Data Analytics Centre The Chinese University of Hong KongHong KongChina

For the detection of steatosis,quantitative ultrasound imaging techniques have achieved great progress in past years.Magnetic resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic steatosis.Some blood biomarkers correlate with non-alcoholic steatohepatitis,but the accuracy is modest.Regarding liver fibrosis,liver stiffness measurement by transient elastography(TE)has high accuracy and is widely used across the world.Magnetic resonance elastography is marginally better than TE but is limited by its cost and availability.Several blood biomarkers of fibrosis have been used in clinical trials and hold promise for selecting patients for treatment and monitoring treatment response.This article reviews new developments in the non-invasive assessment of non-alcoholic fatty liver disease(NAFLD).Accumulating evidence suggests that various non-invasive tests can be used to diagnose NAFLD,assess its severity,and predict the prognosis.Further studies are needed to determine the role of the tests as monitoring tools.We cannot overemphasize the importance of context in selecting appropriate tests.

关键词： Fatty liver Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Liver fibrosis Cirrhosis Transient elastography fibroscan Magnetic resonance imaging

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基于fibroscan和血清学指标预测肝硬化食管静脉曲张的价值

基于FibroScan和血清学指标预测肝硬化食管静脉曲张的价值

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作者：刘婷南昌大学

学位级别：硕士

目的:探讨基于fibroscan检测的肝硬度值(LSM)和血清学指标构建新模型,与无创纤维化模型APRI、FIB-4、King’s Score等对比,评价它们对肝硬化食管静脉曲张的诊断价值。方法:回顾性筛选2020年06月至2022年06月就诊于南昌大学第二附属医院... 详细信息

目的:探讨基于fibroscan检测的肝硬度值(LSM)和血清学指标构建新模型,与无创纤维化模型APRI、FIB-4、King’s Score等对比,评价它们对肝硬化食管静脉曲张的诊断价值。方法:回顾性筛选2020年06月至2022年06月就诊于南昌大学第二附属医院,临床诊断为肝硬化且符合纳入排除标准的193例患者的病历资料,包括:一般资料(如年龄、性别、BMI、有无腹水和肝性脑病等),实验室资料(如血小板、谷丙转氨酶、谷草转氨酶、总胆红素、白蛋白、碱性磷酸酶、γ-谷氨酰基转移酶、凝血酶原时间、国际标准化比率等)以及fibroscan和胃镜结果。依据内镜下结果将患者分为有无食管静脉曲张组(EV)和非高危与高危食管静脉曲张组(HREV)。分别进行单因素分析及二元logistic回归分析,寻找能独立预测EV和HREV的无创指标,并分别构建预测EV和HREV的新模型。以胃镜为金标准绘制LSM、新模型及无创纤维化模型(APRI、FIB-4、King’s Score)的ROC曲线,计算AUC、SE、SP、PPV、NPV、AC等统计学指标,评价各模型对EV及HREV的预测效能。结果:1.在有无EV组中,确定了 LSM、PLT、TBIL为EV的独立预测因子。基于这3项指标构建了新模型a。新模型a的预测效能最高,AUC为0.798,最佳截断值为 0.565,该模型 SP、SE 为 85.70%、65.30%,PPV、NPV 及 AC 分别为81.57%、71.81%和75.66%。其次是LSM,在单独预测EV中也有较好的预测价值,ACU为0.715,最佳截断值为21.85,该模型SE(72.60%)与SP(64.30%)比新模型 a稍低,PPV、NPV 和 AC 分别为 66.35%、70.77%、68.39%。FIB-4、APRI、King’s指数预测效能欠佳。2.在HREV与非HREV组中,确定了 LSM、PLT、ALB、性别、有无腹水为HREV的独立预测因子。在此基础上构建了新模型b。新模型b的AUC达0.907,最佳截断值为0.377,该模型SP(87.90%)较高,SE(77.00%)偏低,其PPV、NPV及AC分别为72.73%、90.12%和84.68%。LSM在单独预测HREV中也展现出良好的预测价值,其AUC达0.849,最佳截断值为22.75KPa,SE 高达 91.8%,SP、PPV、NPV 和 AC 分别为 68.20%、54.75%、95.20%和75.17%。FIB-4、APRI、King’s指数预测效能依旧不佳。结论:1.在有无EV组中,PLT、TBIL和LSM是预测肝硬化EV存在的独立因子;新模型a对EV有较高的预测价值且比LSM及无创纤维化模型高。2.在HREV与非HREV组中,PLT、ALB、LSM及性别、有无腹水是HREV的独立预测因子;新模型b对HREV的预测价值也比LSM及无创纤维化模型高。

关键词：肝硬化食管静脉曲张 fibroscan 肝硬度值无创肝纤维化诊断模型

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Association of maternal obesity and gestational diabetes mellitus with overweight/obesity and fatty liver risk in offspring

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World Journal of Gastroenterology 2022年第16期28卷 1681-1691页

作者： Jing Zeng Feng Shen Zi-Yuan Zou Rui-Xu Yang Qian Jin Jing Yang Guang-Yu Chen Jian-Gao Fan Department of Gastroenterology Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghai 200092China Shanghai Key Lab of Pediatric Gastroenterology and Nutrition Shanghai 200092China

BACKGROUND Childhood obesity and fatty liver are associated with adverse outcomes such as diabetes,metabolic syndrome,and cardiovascular diseases in adulthood.It is very important to identify relevant risk factors and intervene as early as possible.At present,the relationship between maternal and offspring metabolic factors is conflicting.AIM To estimate the association of maternal obesity and gestational diabetes mellitus(GDM)with overweight/obesity and fatty liver risk in offspring at 8 years of age.METHODS The prospective study included mothers who all had a 75-g oral glucose tolerance test at 24-28 wk of gestation and whose offspring completed follow-up at 8 years of age.Offspring birth weight,sex,height,weight,and body mass index(BMI)were measured and calculated.fibroscan-502 examination with an M probe(Echosens,Paris,France)was prospectively conducted in offspring aged 8 years from the Shanghai Prenatal Cohort Study.RESULTS A total of 430 mother-child pairs were included in the analysis.A total of 62(14.2%)mothers were classified as obese,and 48(11.1%)were classified as having GDM.The mean age of the offspring at follow-up was 8 years old.Thirty-seven(8.6%)offspring were overweight,14(3.3%)had obesity,and 60(14.0%)had fatty liver.The prevalence of overweight,obesity and fatty liver in offspring increased significantly across maternal BMI quartiles(all P<0.05).Among offspring of mothers with GDM,12(25.0%)were overweight,4(8.3%)were obese,and 12(25.0%)had fatty liver vs.25(6.5%),10(2.6%)and 48(12.6%),respectively,for offspring of mothers without GDM(all P<0.05).In multiple logistic regression,after adjustment for variables,the OR for fatty liver in offspring was 8.26(95%CI:2.38-28.75)for maternal obesity and GDM.CONCLUSION This study showed that maternal obesity can increase the odds of overweight/obesity and fatty liver in offspring,and GDM status also increases the odds of overweight/obesity in offspring.Weight management and glycemic control before and during pregnancy need to be highlighted in primary pre

关键词： Maternal obesity Gestational diabetes mellitus Offspring overweight/obesity Offspring fatty liver fibroscan

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