双模态磁共振氢质子密度脂肪分数对非酒精性脂肪性肝病分级的诊断价值  

Diagnostic value of bimodal magnetic resonance ^(1)H proton density fat fraction in grading of nonalcoholic fatty liver disease

作　　者：梁珊[1] 齐石[2] 王欣欣[3] 仇丽霞[1] 范作鹏[1] 刘晓慧[1] 韦新焕[1] 马丽霞[1] 柳雅立[1] 张晶[1] LIANG Shan;QI Shi;WANG Xin-xin;QIU Li-xia;FAN Zuo-peng;LIU Xiao-hui;WEI Xin-huan;MA Li-xia;LIU Ya-li;ZHANG Jing(The Third Department of Hepatology Center,Beijng Youan Hospital,Capital Medical University,100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝病中心三科,100069 [2]首都医科大学附属北京佑安医院放射科,100069 [3]首都医科大学附属北京佑安医院病理科,100069

出　　处：《传染病信息》2022年第1期69-74,共6页Infectious Disease Information

基　　金：首都卫生发展基金(2020-1-3011);北京佑安医院院内课题(YBKT-YNKTTS-20180108)。

摘　　要：目的探讨2种磁共振模态下氢质子密度脂肪分数(1H proton density fat fraction,PDFF)评价非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者脂肪变定量诊断和分级价值。方法单中心、前瞻性入组2015年3月—2020年1月之间首都医科大学附属北京佑安医院脂肪肝门诊符合NAFLD诊断标准患者173例,进行MRI-PDFF、MRSPDFF检查,其中55例患者行肝脏病理学检查。依据肝脏病理脂肪含量将肝脂肪变分为S0~S3共4级,结合脂肪变、小叶炎症和气球样变进行NAFLD活动度评分(NAFLD activity score,NAS)。2种PDFF分别与身体质量指数、肝脏生化、血脂、受控衰减指数(controlled attenuation parameter,CAP)进行相关性分析。应用ROC曲线评估MRI-PDFF和MRS-PDFF对NAS的预测效能。结果173例患者测得MRS-PDFF和MRI-PDFF范围分别为0.55%~45.36%,2.85%~68.90%。PDFF水平与ALT、LDL-C、TG、TC、尿酸水平呈正相关,与HDL-C水平则呈现负相关,(P均<0.05)与APRI指数和FIB-4指数未显示相关。(P均<0.05)55例肝穿病理结果提示脂肪变分级S1级20例,S2级16例,S3级19例,无S0级脂肪变患者。NAS评分0~3分14例,4分9例,>4分32例,MRS-PDFF和MRI-PDFF与肝脂肪变分级呈线性相关。MRIPDFF和MRS-PDFF用于预测诊断非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)(NAS>4分)AUC分别为0.884和0.866。结论2种模态PDFF均可用来诊断肝脏脂肪变程度,预测NASH具有价值,且2者诊断效能相近。Objective To investigate the quantitative diagnostic and grading value of H proton density fat fraction(PDFF)s in 2 magnetic resonance modes in the evaluation of fatty changes in patients with non-alcoholic fatty liver disease(NAFLD).MethodA total of 173 patients who met NAFLD diagnostic criteria in the outpatient Clinic of Beijing Youan Hospital,Capital Medical University from March 2015 to January 2020 were prospectively enrolled in a single-center study,and underwent MRI-PDFF and MR-PDFF examinations,55 of whom underwent liver biopsy examination.Hepatic steatosis was divided into 4 grades,S0-S3,according to the pathological fat content of the liver,and NAS score was combined with fatty steatosis,lobular inflammation and hepatocyte ballooning.The correlation between the 2 PDFF types and BMI,liver biochemistry,lipid,controlled attenuation param analyzed.Area under ROC curves were used to evaluate the predictive power of MRI-PDFF and MRS-PDFF for NAS.Reteesr u(CltAsP)was The range of MRS-PDFF and MRI-PDFF in 173 patients was 0.55%-45.36%and 2.85%-68.90%,respectively.PDFF level was positively correlated with ALT,LDL-C,TG,TC,UA,and negatively correlated with HDL,but not with APRI index and FIB-4 index.The pathological results of the 55 case>s showed that there were S1 grade 20 cases,S216 cases and S319 cases with grade S0.NAS scores were 0-3 in 14 cases,4 icnu r9 v ecsa ses,4(NASH)in 32 cases.MRS-PDFF and MRI-PDFF were linearly correlated with hepatic steatosis grade.Area under ROC of MRI-PDFF and MRS-PDFF used to predict NASH(NAS>4)was 0.884 and 0.866,respectively.Conclusions Both modes of PDFF can be used to diagnose hepatic steatosis and have value in predicting NASH,and their diagnostic efficacy is similar.

关 键 词：非酒精性脂肪性肝病 脂肪性肝炎 氢质子密度脂肪分数 诊断 

分 类 号：R512.57[医药卫生—内科学] R195.4[医药卫生—临床医学]