超声E成像及MR mDixon序列检查对非酒精性脂肪性肝病的诊断价值

摘要/Abstract

摘要： 目的探讨超声E成像及MR mDixon序列检查对非酒精性脂肪性肝病(NAFLD)的诊断意义。方法纳入2020年1月至2022年6月广西医科大学第一附属医院诊治的NAFLD患者147例(轻度58例,中度59例,重度30例)和同期体检健康人125例,均接受超声E成像和MR mDixon序列检查获取肝杨氏模量和脂肪含量。采用Spearman相关分析评价NAFLD病情严重程度与肝杨氏模量和脂肪含量的相关性,受试者工作特征曲线(ROC)下面积(AUC)评估肝杨氏模量及脂肪含量诊断重度NAFLD的效能。结果 NAFLD患者AST、ALT、ALP和TBil分别为(19.62±5.54)U/L、(27.82±7.10)U/L、(70.57±7.90)IU/L和(40.72±11.34)μmol/L,高于健康人的(17.20±5.30)U/L、(17.54±5.33)U/L、(67.95±7.82)U/L和(11.50±5.45)μmol/L(P<0.05)。重度NAFLD患者AST、ALT、ALP和TBIL分别为(24.64±5.21)U/L、(30.24±4.00)U/L、(75.33±10.60)U/L和(47.43±11.20)μmol/L,高于中度NAFLD患者的(20.50±5.71)U/L、(29.00±4.87)U/L、(70.50±10.61)U/L和(42.56±9.40)μmol/L(P<0.05)和轻度NAFLD患者的(16.20±3.42)U/L、(25.31±4.71)U/L、(67.10±7.55)U/L和(35.40±8.24)μmol/L(P<0.05)。NAFLD患者肝杨氏模量和脂肪含量分别为(5.30±1.52)kPa和(5.34±1.20)%,高于健康人的(3.04±1.22)kPa和(3.40±1.11)%(P<0.05)。重度NAFLD患者肝杨氏模量和脂肪含量分别为(7.30±1.30)kPa和(6.80±1.23)%,高于中度NAFLD患者的(5.21±1.41)kPa和(5.50±1.14)%(P<0.05)和轻度NAFLD患者的(4.30±1.32)kPa和(4.21±0.90)%(P<0.05)。Spearman相关分析结果显示,NAFLD病情严重程度与肝杨氏模量和脂肪含量均呈正相关(r=0.680、0.526,均P<0.01)。ROC曲线分析结果显示肝杨氏模量和脂肪含量单独诊断重度NAFLD的AUC分别为0.867和0.849,低于两者联合诊断的0.946(P<0.05)。结论采用超声E成像和MR mDixon序列检查可精确测得肝杨氏模量和脂肪含量,对诊断NAFLD患者病情严重程度具有较高的效能。

关键词: 超声E成像, MR mDixon序列, 非酒精性脂肪性肝病, 肝杨氏模量, 脂肪含量

Abstract: Objective To investigate the diagnostic value of ultrasound E imaging and MR mDixon sequence examination in nonalcoholic fatty liver disease (NAFLD).Methods 147 NAFLD patients (58 mild cases, 59 moderate cases, 30 severe cases) and 125 healthy subjects were diagnosed and treated in our hospital between January 2020 and June 2022, all patients underwent ultrasound E imaging and MR mDixon sequence examination to obtain liver young's modulus and fat content. Spearman correlation analysis was used to evaluate the correlation between the severity of NAFLD and liver young's modulus and fat content. Area under receiver operating characteristic curve (AUC) was used to evaluate the efficacy of young's modulus and fat content in the diagnosis of severe NAFLD.Results AST, ALT, ALP and TBIL in NAFLD patients were (19.62±5.54) IU/L, (27.82±7.10) IU/L, (70.57±7.90) IU/L and (40.72±11.34) μmol/L, respectively, higher than that in healthy subjects [(17.20±5.30) IU/L, (17.54±5.33) IU/L, (67.95±7.82) IU/L and (11.50±5.45) μmol/L, respectively, P<0.05]. AST, ALT, ALP and TBIL in patients with severe NAFLD were (24.64±5.21) IU/L, (30.24±4.00) IU/L, (75.33±10.60) IU/L and (47.43±11.20) μmol/L, respectively, higher than that of patients with moderate NAFLD [(20.50±5.71) IU/L, (29.00±4.87) IU/L, (70.50±10.61) IU/L and (42.56±9.40) μmol/L, respectively, P<0.05] and patients with mild NAFLD [(16.20±3.42) IU/L, (25.31±4.71) IU/L, (67.10±7.55) IU/L and (35.40±8.24) μmol/L, respectively, P<0.05]. Liver young's modulus and fat content in NAFLD patients were (5.30±1.52) kPa and (5.34±1.20) %, respectively, which were higher than those in healthy subjects [(3.04±1.22) kPa and (3.40±1.11) %, respectively, P<0.05)]. Liver Young's modulus and fat content in patients with severe NAFLD were (7.30±1.30) kPa and (6.80±1.23) %, respectively, which were higher than those in patients with moderate NAFLD [5.21±1.41) kPa and (5.50±1.14) %, respectively, P<0.05] and mild NAFLD patients [(4.30±1.32) kPa and (4.21±0.90) %, respectively, P<0.05]. Spearman correlation analysis showed that the severity of NAFLD was positively correlated with liver Young's modulus and fat content (r=0.680, 0.526, P=0.000, 0.000). ROC curve analysis showed that the AUC of young's modulus and fat content in liver in the diagnosis of severe NAFLD was 0.867 and 0.849 respectively, which was lower than that of 0.946 in the combined diagnosis of young's modulus and fat content (P<0.05).Conclusion Ultrasound E imaging and MR mDixon sequence examination can accurately measure young's modulus and fat content of liver, which has high efficacy in diagnosing the severity of NAFLD patients.

Key words: Ultrasonic E imaging, MR mDixon sequence, Nonalcoholic fatty liver disease, Young's modulus of liver, Fat content

钟献凤, 陈桂娥, 陈彦婵, 黄健源. 超声E成像及MR mDixon序列检查对非酒精性脂肪性肝病的诊断价值[J]. 肝脏, 2023, 28(5): 585-589.

ZHONG Xian-feng, CHEN Gui'e, CHEN Yan-chan, HUANG Jian-yuan. The diagnostic value of ultrasound E imaging and MR mDixon sequence in non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2023, 28(5): 585-589.

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