不同肝组织学特征非肥胖型NAFLD患者磁共振质子密度脂肪分数表现

肝脏 ›› 2022, Vol. 27 ›› Issue (5): 573-575.

不同肝组织学特征非肥胖型NAFLD患者磁共振质子密度脂肪分数表现

王铁钢, 李小明, 朱丹阳

063000 河北唐山市中医医院西院区放射科

收稿日期:2021-11-05 出版日期:2022-05-31 发布日期:2022-07-13
通讯作者: 朱丹阳,Email:1939203710@qq.com
基金资助:
河北省自然科学基金(H20182384721)

MRI proton density and fat fraction in non-obese NAFLD patients with different liver histological characteristics

WANG Tie-gang, LI Xiao-ming, ZHU Dan-yang

Department of Radiology, West Hospital, Tangshan Hospital of Traditional Chinese Medicine, Hebei 063000, China

Received:2021-11-05 Online:2022-05-31 Published:2022-07-13
Contact: ZHU Dan-yang,Email:1939203710@qq.com

摘要/Abstract

摘要： 目的比较非肥胖型非酒精性脂肪性肝病(NAFLD)、慢性乙型肝炎(CHB)患者临床资料,分析不同肝脂肪变程度、肝组织炎症程度及肝纤维化分期等肝组织学特征非肥胖型NAFLD患者磁共振质子密度脂肪分数(MRI-PDFF)表现。方法收集2019年1月至2021年7月期间非肥胖型NAFLD患者74例(男40例,女34例),年龄(42.3±11.4)岁;CHB患者92例(男64例,女性28例),年龄(38.1±10.3)岁。非肥胖型NAFLD、CHB诊断符合标准,比较患者临床资料,分析不同肝组织学特征非肥胖型NAFLD患者MRI-PDFF表现。结果非肥胖型NAFLD、CHB患者高血压为29例(39.2%)、11例(12.0%),差异具有统计学意义(χ²=16.629,P<0.05);非肥胖型NAFLD患者TG、TC、LDL及HDL为(2.4±1.0)mmol/L、(5.3±1.4)mmol/L、(3.5±0.9)mmol/L及(1.0±0.4)mmol/L,与CHB患者[分别为(1.2±0.6)mmol/L、(4.0±1.0)mmol/L、(2.3±0.6)mmol/L及(1.5±0.6)mmol/L]比,差异具有统计学意义(t=10.502,4.104,4.230,-5.018,P<0.05);非肥胖型NAFLD、CHB患者MRI-PDFF为(16.5±5.2)%、(3.8±1.1)%,差异具有统计学意义(t=22.428,P<0.05)。NAFLD患者肝脂肪变程度S0级10例,S1级25例,S2级28例及S3级11例,各肝脂肪变程度MRI-PDFF分别为(3.3±1.5)%、(9.2±3.3)%、(16.2±5.0)%及(21.4±6.4)%,差异具有统计学意义(t=12.234,P<0.05),而各肝组织炎症程度、肝纤维化分期患者MRI-PDFF差异不具有统计学意义(P>0.05)。结论随着非肥胖型NAFLD患者肝脂肪变程度增加,MRI-PDFF显著上升,有助于定量评价非肥胖型NAFLD患者肝脏脂肪含量。

关键词: 非肥胖型非酒精性脂肪肝病, 磁共振质子密度脂肪分数, 肝脂肪变程度

Abstract: Objective To compare the clinical data of non-obese nonalcoholic fatty liver disease (NAFLD) patients with those of chronic hepatitis B (CHB) patients, and analyze the performance of magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF) of non-obese NAFLD patients with different liver histological features such as the degrees of steatosis and inflammation, and the stages of liver fibrosis. Methods A total of 74 non-obese NAFLD patients (40 males and 34 females) aged (42.3±11.4) years from January 2019 to July 2021 were collected. There were 92 patients with CHB (64 males and 28 females) with an average age of (38.1±10.3) years. The diagnosis of non-obese NAFLD and CHB meet the standard criteria. The clinical data of non-obese NAFLD patients were compared with CHB patients. The associations between MRI-PDFF manifestations with different liver histological features were analyzed. Results There were 29 cases (39.2%) and 11 cases (12.0%) of hypertension in non-obese NAFLD and CHB patients, respectively, with statistical significance (χ²=16.629, P<0.05). The levels of total triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) in non-obese NAFLD patients were (2.4±1.0) mmol/L, (5.3±1.4) mmol/L, (3.5±0.9) mmol/L and (1.0±0.4) mmol/L, respectively, which were significantly higher than those of [(1.2±0.6) mmol/L, (4.0±1.0) mmol/L, (2.3±0.6) mmol/L and (1.5±0.6) mmol/L in CHB patients (t=10.502, 4.104, 4.230, -5.018, P<0.05). The MRI-PDFF of non-obese NAFLD and CHB patients were (16.5±5.2)% and (3.8±1.1)%, respectively, with statistical significance (t=22.428, P<0.05). For the degrees of hepatic steatosis of the non-obese NAFLD patients, 10 cases were in S0, 25 cases were in S1, 28 cases were in S2 and 11 cases were in S3. The MRI-PDFF of each degree of hepatic steatosis was (3.3±1.5)%, (9.2±3.3)%, (16.2±5.0)% and (21.4±6.4)%, respectively, with statistical significance (t=12.234, P<0.05). However, there was no significant difference in MRI-PDFF among patients with different liver inflammatory degrees and liver fibrosis stages (P>0.05). Conclusion With the increased severity of liver steatosis in non-obese NAFLD patients, The MRI-PDFF significantly increase which is helpful to quantitatively evaluate liver fat content and improve the diagnosis.

Key words: Non-obese nonalcoholic fatty liver disease, Magnetic resonance imaging-proton density fat fraction, Degree of hepatic steatosis

王铁钢, 李小明, 朱丹阳. 不同肝组织学特征非肥胖型NAFLD患者磁共振质子密度脂肪分数表现[J]. 肝脏, 2022, 27(5): 573-575.

WANG Tie-gang, LI Xiao-ming, ZHU Dan-yang. MRI proton density and fat fraction in non-obese NAFLD patients with different liver histological characteristics[J]. Chinese Hepatolgy, 2022, 27(5): 573-575.

参考文献

[1] Ye Q, Zou B, Yeo YH, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol, 2020, 5(8):739-752.
[2] Zou Y, Yu M, Sheng G. Association between fasting plasma glucose and nonalcoholic fatty liver disease in a nonobese Chinese population with normal blood lipid levels: a prospective cohort study. Lipids Health Dis, 2020, 19(1):145.
[3] Xu S, Chen L, Hong D, et al. Mean arterial pressure is related to incident nonalcoholic fatty liver disease among the nonobese female with normal low-density lipoprotein cholesterol levels: a large cohort study in China. Gastroenterol Res Pract, 2020, 2020:3580840.
[4] Gaiani S, Avogaro A, Bombonato GC, et al. Nonalcoholic fatty liver disease (NAFLD) in nonobese patients with diabetes: Prevalence and relationships with hemodynamic alterations detected with Doppler sonography. J Ultrasound, 2009, 12(1):1-5.
[5] Kim SH, Park HY, Lee HS, et al. Association between non-alcoholic fatty liver disease and coronary calcification depending on sex and obesity. Sci Rep, 2020, 10(1):1025.
[6] Sun DQ, Wu SJ, Liu WY, et al. Association of low-density lipoprotein cholesterol within the normal range and NAFLD in the non-obese Chinese population: a cross-sectional and longitudinal study. BMJ Open, 2016, 6(12):e013781.
[7] Satkunasingham J, Nik HH, Fischer S, et al. Can negligible hepatic steatosis determined by magnetic resonance imaging-proton density fat fraction obviate the need for liver biopsy in potential liver donors?. Liver Transpl, 2018, 24(4):470-477.
[8] 瞿欢佳, 王磊, 金沛桦, 等. 氢质子磁共振波谱在脂肪性肝病肝脏甘油三酯含量测定中的价值及其影响因素. 中华肝脏病杂志, 2017, 25(11): 858-863.
[9] 徐亮, 钟燕, 苏淑婷, 等. 反应性氧化物、脂联素在慢性乙型肝炎病毒感染合并非酒精性脂肪性肝病中的研究. 中华肝脏病杂志, 2020, 28(3): 247-253.
[10] Xu N, Xie Q, Li J, et al. Improvement in liver stiffness measurement for diagnosis of liver fibrosis in patients with concurrent chronic hepatitis B and nonalcoholic fatty liver disease. J Int Med Res, 2020, 48(2):300060520903667.
[11] Lee SJ, Kim SU. Noninvasive monitoring of hepatic steatosis: controlled attenuation parameter and magnetic resonance imaging-proton density fat fraction in patients with nonalcoholic fatty liver disease. Expert Rev Gastroenterol Hepatol, 2019, 13(6):523-530.
[12] 中华医学会肝病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南. 中华糖尿病杂志, 2010, 2(1): 15-19.
[13] 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪肝专家委员会. 非酒精性脂肪性肝病防治指南(2018年版). 实用肝脏病杂志, 2018, 21(2):177-186.
[14] Liao R, Fu YP, Wang T, et al. Metavir and FIB-4 scores are associated with patient prognosis after curative hepatectomy in hepatitis B virus-related hepatocellular carcinoma:a retrospective cohort study at two centers in China. Oncotarget, 2017, 8(1): 1774-1781.
[15] Eshraghian A, Nikeghbalian S, Geramizadeh B, et al. Characterization of biopsy proven non-alcoholic fatty liver disease in healthy non-obese and lean population of living liver donors: The impact of uric acid. Clin Res Hepatol Gastroenterol, 2020, 44(4):572-578.
[16] Gu J, Liu S, Du S, et al. Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: a meta-analysis. Eur Radiol, 2019, 29(7):3564-3573.
[17] Caussy C, Alquiraish MH, Nguyen P, et al. Optimal threshold of controlled attenuation parameter with MRI-PDFF as the gold standard for the detection of hepatic steatosis. Hepatology, 2018, 67(4):1348-1359.