肝内铁、脂沉积对ADC值评估慢性乙型肝炎患者肝纤维化的影响  

Influence of liver iron overload and steatosis on ADC value in evaluating liver fibrosis in patients with chronic hepatitis B

作　　者：盘中贤 李主镜 廖炯[1] 郝连涛 孟凡琦 胡元明[1] 黄嵘[2] 杨晓燕[1] 文武成 陈玥瑶 PAN Zhongxian;LI Zhujing;LIAO Jiong;HAO Liantao;MENG Fanqi;HU Yuanming;HUANG Rong;YANG Xiaoyan;WEN Wucheng;CHEN Yueyao(Department of Radiology,Shenzhen Traditional Chinese Medicine Hospital,the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine,Shenzhen 518033,China;Department of Radiology,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]深圳市中医院(广州中医药大学第四临床医学院)放射影像科,深圳518033 [2]北京大学深圳医院放射影像科,深圳518036

出　　处：《磁共振成像》2021年第7期18-23,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(编号:81903960)。

摘　　要：目的探讨肝铁过载和脂肪肝对ADC值评估慢性乙型肝炎患者肝纤维化的影响。材料与方法纳入73例慢性乙型肝炎患者,应用多回波Dixon序列检测肝R2*值及质子密度脂肪分数(proton density fat fraction,PDFF),分别评估肝铁过载和脂肪肝。根据有或无肝铁过载或脂肪肝进行分组,比较组间ADC值差异。采用WHO推荐的肝纤维化替代标准进行肝纤维化分级。分析ADC值与R2*、PDFF、肝纤维化分级的相关性,多元线性回归分析ADC值的影响因素。剔除肝铁过载或(和)脂肪肝患者后,再分析ADC值与肝纤维化分级的相关性。结果肝铁过载组及脂肪肝组的ADC值均显著降低(P均<0.05)。R2*、PDFF及肝纤维化分级均与ADC值呈负相关(r=-0.457、-0.298、-0.385,P均<0.05),且是ADC值的影响因素(标准化回归系数=-0.307、-0.382、-0.412,t=-2.666、-3.331、-3.510;P均<0.05)。剔除肝铁过载或(和)脂肪肝患者后,ADC值与肝纤维化分级的相关性明显提高,相关系数分别为-0.573、-0.456、-0.688,P均<0.05。结论肝铁过载和脂肪肝会导致ADC值降低,影响ADC值与肝纤维化分级的相关性。应用ADC值评估慢性乙型肝炎患者肝纤维化时,需注意肝铁过载和脂肪肝的影响。Objective:To investigate the effect of hepatic iron overload and steatosis on ADC value in evaluating liver fibrosis in patients with chronic hepatitis B(CHB).Materials and Methods:Seventy-three patients with CHB were included in this study.R2*and proton density fat fraction(PDFF)were measured by multi-echo Dixon for the diagnosis of hepatic iron overload and steatosis,respectively.Patients were grouped according to the presence or absence of liver iron overload and steatosis.The differences of ADC values between the groups were estimated.Liver fibrosis grading was performed according to an alternative standard recommended by WHO.The correlation between ADC values and R2*,PDFF,fibrosis grade,age,gender was analysed.Multiple linear regression analysis was performed.The correlation between ADC values and fibrosis grade was analysed after excluding patients with liver iron overload or/and steatosis.Results:The ADC values of the liver iron overload group and the steatosis group were significantly reduced(P<0.05).R2*,PDFF,and liver fibrosis grade were all negatively correlated with ADC values(r=-0.457,-0.298,-0.385,respectively,P<0.05).And they were affecting factors of ADC values(standardized regression coefficient=-0.307,-0.382,-0.412;t=-2.666,-3.331,-3.510;respectively,P<0.05).After excluding patients with liver iron overload or/and steatosis,the correlation between ADC value and liver fibrosis grade was significantly improved,and the correlation coefficients were-0.573,-0.456,and-0.688,respectively,P<0.05.Conclusions:Hepatic iron overload and steatosis could reduce the ADC value and additionally affect the correlation between ADC values and liver fibrosis grade.When using ADC value to evaluate liver fibrosis in patients with CHB,the influence of liver iron overload and steatosis should be noticed.

关 键 词：慢性乙型肝炎 铁过载 脂肪肝 肝纤维化 扩散加权成像 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R512.62[医药卫生—诊断学]