兔脂肪肝的综合定量诊断  

Comprehensively quantitative assessment of hepatic steatosis in rabbits

作　　者：苏中振[1] 练荣丽[2] 何炳钧[1] 孟晓春[1] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,广东广州510630 [2]中山大学附属第三医院感染科,广东广州510630

出　　处：《中国医学影像技术》2009年第S1期11-14,共4页Chinese Journal of Medical Imaging Technology

基　　金：广东自然科学基金团队研究项目基金(05200177);广东省自然科学基金(06021217)

摘　　要：目的寻找和筛选脂肪肝定量诊断的最佳预测指标,建立多指标联合定量诊断脂肪肝的新方法。方法选用45只健康新西兰大白兔,采用高脂高糖饲料加酒精饮料建立不同程度脂肪肝模型,应用大体观测、血生化、超声(US)、计算机断层扫描(CT)及质子磁共振波谱(1H-MRS)多种临床诊断手段,对22个观测指标进行筛选,寻找脂肪肝定量诊断的最佳预测指标,并建立脂肪肝综合定量诊断的数学模型;通过ROC曲线分析比较多指标联合应用与单指标应用诊断脂肪肝的价值。结果肝脏湿重、肝脏指数、肝CT值、肝/腰大肌密度比率、1H-MRS脂肪峰值、脂肪波峰下面积、脂/水波峰下面积比率、脂肪百分比、超声衰减系数、谷草转氨酶(AST)、胆固醇(TC)、甘油三脂(TG)等12个指标存在组间差异性,且与脂肪肝分级诊断具有显著性相关,其中肝脏指数、肝CT值和血TC为脂肪肝分级诊断的最佳预测指标,数学模型为Y=1.98+3.91×10-2X1+0.37X2-2.84×10-2X3(Y:脂肪肝分级;X1:血TC;X2:肝脏指数;X3:肝CT值);ROC分析显示多指标联合应用(Y)诊断脂肪肝的价值优于单指标应用。结论联合应用多种诊断手段,综合考虑多个最佳预测指标的综合诊断方法,能够为临床快速、准确地判断脂肪肝程度提供帮助。Objective To select the most powerful predictors for the quantitative evaluation of hepatic steatosis grade,and find a comprehensively quantitative diagnosis method of fatty liver by combined application several diagnostic indexes.Methods Forty-five healthy New Zealand rabbits were enrolled into the study.Hepatic steatosis models were established by feeding high-fat,high-sugar diet and drinking water containing 5% ethanol.Twenty-two variable indexes were measured with general observation,biochemical examination,ultrasonography(US),computed tomography(CT),and proton magnetic resonance spectroscopy(1H-MRS).Stepwise regression analysis was used to select the most powerful predictors.ROC analysis was used to compare the diagnostic efficacy of single index with combined index(Y).Results There were 12 variable indexes with significant differences among groups,which correlated with hepatic steatosis grade:liver weight,hepatic index,liver CT value,liver-to-muscle attenuation ratio,1H-MRS fat peak value,fat peak area,fat-to-water peak area ratio,fat percentage,ultrasound attenuation coefficient,serum AST,TC and TG.Among them hepatic index,liver CT value and serum TC were selected as the most powerful predictors.The regression equation was:Y=1.98+3.91×10-2X1+0.37X2-2.84×10-2X3,(Y:hepatic steatosis grade;X1:TC;X2:hepatic index;X3:liver CT value.ROC analysis displayed PPV,NPV,curve area of combined index(Y)were superior to simple index(hepatic index,liver CT value and serum TC)in evaluating hepatic steatosis grade.Conclusion Combined application of several diagnostic methods is superior to simple method,and can make comprehensive,rapid,accurate evaluation of hepatic steatosis grade.

关 键 词：脂肪肝 定量诊断 

分 类 号：R575.5[医药卫生—消化系统]