乙型肝炎病毒所致慢性肝病病人肝脏铁沉积和脂肪变性的MRI定量研究  

Quantitative MRI study of hepatic iron deposition and steatosis in patients with chronic hepatitis B virus (HBV)-induced liver disease

作　　者：郭雅雯 王晓楠[1] 曹宇[2] 王瑞航 姚升娟[2] 孙彤彤 倪红艳[3] GUO Yawen;WANG Xiaonan;CAO Yu;WANG Ruihang;YAO Shengjuan;SUN Tongtong;NI Hongyan(First Central Clinical School,Tianjin Medical University,Tianjin 300192,China;Department of Radiology,Tianjin Second People’s Hospital;Department of Radiology,Tianjin First Central Hospita)

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第二人民医院放射科 [3]天津市第一中心医院放射科

出　　处：《国际医学放射学杂志》2022年第3期249-254,共6页International Journal of Medical Radiology

基　　金：天津市卫生局攻关课题(15KG134);天津市教委基金资助项目(2019YJSS177)。

摘　　要：目的根据多回波Dixon技术定量测得的R_(2)*值和质子密度脂肪分数(PDFF)评价乙型肝炎病毒(HBV)所致慢性肝病病人的肝脏铁含量和脂肪含量,探讨定量测量与病情进展的关系。方法回顾性分析97例HBV所致慢性肝病病人,所有病人均行钆塞酸二钠(Gd-EOB-DTPA)增强MRI检查。根据病情进展状态将病人分为3组,慢性乙型肝炎(CHB)组21例,乙肝肝硬化(LC)组44例,LC合并肝细胞癌(HCC)组32例。另外纳入正常对照(NC)组20例。全部研究对象均进行了MRI多回波Dixon序列扫描,测量其肝实质R_(2)*值和PDFF;测量HCC病人病灶处的R_(2)*值和PDFF,获取所有LC病人的肝功能Child-Pugh评分。采用Kruskal-Wallis检验比较组间R_(2)*值和PDFF差异;采用配对t检验比较HCC组病灶与邻近正常肝组织的R_(2)*和PDFF。采用Spearman相关分析所有受试者R_(2)*值与PDFF,及LC病人Child-Pugh评分与其R_(2)*值、PDFF之间的相关性。结果(1)LC组、HCC组R_(2)*均高于NC组(均P<0.05),HCC组R_(2)*高于CHB组(P<0.05);HCC组PDFF高于NC组(P<0.05)。其余2组间R_(2)*和PDFF的差异均无统计学意义(均P>0.05)。(2)HCC病人病灶处的R_(2)*低于邻近正常肝组织(P<0.05),而两者PDFF差异无统计学意义(P>0.05)。(3)所有受试者R_(2)*与PDFF呈正相关(r=0.558,P<0.05),LC病人肝脏R_(2)*与Child-Pugh评分呈正相关(r=0.336,P<0.05),PDFF与Child-Pugh评分无相关性(r=0.102,P>0.05)。结论HBV所致慢性肝病病人可出现肝脏铁沉积和脂肪变性;随着病情的进展,肝脏铁含量和脂肪含量呈升高趋势;癌变病灶表现为肝脏富铁背景下的乏铁灶。Objective To evaluate the liver iron content and fat content in patients with chronic liver disease caused by hepatitis B virus(HBV) based on R_(2)* values and proton density fat fraction(PDFF) measured quantitatively with the multi-echo Dixon technique,and exploring the relationship between quantitative measurements and disease progression.Methods Retrospective analysis of 97 patients with chronic liver disease due to HBV was conducted,all participants had undergone gadoxetic acid disodium(Gd-EOB-DTPA)-enhanced MRI.Patients were divided into 3 groups according to their disease progression status:21 cases in the chronic hepatitis B(CHB) group,44 cases in the hepatitis B cirrhosis(LC) group,and 32 cases in the LC combined with hepatocellular carcinoma(HCC) group.An additional 20 cases in a normal control(NC) group were included.All study subjects had undergone MRI multi-echo Dixon sequence scans to measure their liver parenchymal R_(2)* values and PDFF.R_(2)* values and PDFF were measured at the lesions in the HCC patients,and liver function Child-Pugh scores were obtained for all LC patients.The Kruskal-Wallis test was used to compare the differences in R_(2)* values and PDFF among groups;the paired t-test was used to compare the R_(2)* and PDFF of the lesions in the HCC group with those of the adjacent normal-appearance liver tissue.Spearman correlation was used to analyse the correlation between R_(2)* values and PDFF of all subjects,and between the Child-Pugh scores of LC patients and their R_(2)* values and PDFF.Results(1)The R_(2)* was significantly higher in the LC and HCC groups than in the NC group(both P<0.05),and the R_(2)* was significantly higher in the HCC group than in the CHB group(P<0.05).The PDFF was significantly higher in the HCC group than in the NC group(P<0.05).The differences in R_(2)* and PDFF between the other 2 groups were not statistically significant(all P >0.05).(2) The R_(2)*of the lesion in the HCC patients was significantly lower than that of adjacent normal-appearance liver tissue

关 键 词：乙肝病毒 慢性肝病 铁沉积 脂肪变性 定量磁共振成像 

分 类 号：R575[医药卫生—消化系统] R575[医药卫生—内科学]