超重/肥胖非酒精性脂肪性肝病儿童磁共振质子密度脂肪分数检测意义研究*

doi:10.3969/j.issn.1672-5069.2024.04.009

摘要/Abstract

摘要： 目的探讨应用磁共振质子密度脂肪分数(MRI-PDFF)诊断超重和肥胖儿童非酒精性脂肪性肝炎(NASH)的效能。方法 2022年12月～2023年12月江油市903医院诊治的超重/肥胖的非酒精性脂肪性肝病(NAFLD)儿童102例,其中超重儿童74例和肥胖儿童28例,使用3.0 T MRI扫描仪行肝脏检查,获取MRI-PDFF,使用FibroScan 诊断仪检查获得肝脏硬度检测(LSM)和受控衰减参数(CAP),行肝穿刺诊断NASH,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估诊断效能。结果在102例超重/肥胖的NAFLD儿童中,经组织学检查诊断单纯性非酒精性脂肪肝(SNFL)75例和NASH 27例;NASH组BMI、血清ALT、AST、TG、MRI-PDFF、LSM和CAP分别为(32.2±3.4)kg/m²、(92.7±31.3)U/L、(96.8±34.1)U/L、(3.1±1.2)mmol/L、(12.5±4.7)%、(11.7±1.4)kPa和(370.4±146.9)dB/m,与SNFL组【分别为(26.7±2.2)kg/m²、(38.2±4.4)U/L、(33.0±3.4)U/L、(2.3±0.7)mmol/L、(7.7±2.0)%、(6.2±1.0)kPa和(262.3±61.2)dB/m】比,差异具有统计学意义(P<0.05),NASH组超重和肥胖占比分别37.0%和63.0%,与SNFL组的85.3%和14.7%比,差异具有统计学意义(P<0.05); 经ROC曲线分析显示,以MRI-PDFF为11.9%为截断点,其诊断NASH的AUC为0.87(95%CI为0.80～0.93),敏感性为81.5%,特异性为85.3%,而分别以LSM为10.8 kPa和CAP为310.5dB/m为截断点,其诊断的AUC为0.81(95%CI为0.78～0.89),敏感性为85.2%,特异性为58.7%,后者的特异性较差。结论应用MRI-PDFF诊断儿童NASH的效能较优,但考虑到临床的便捷性,使用弹性成像检测诊断也可获得初步结果,以便必要时进一步检查。

关键词: 非酒精性脂肪性肝炎, 磁共振质子密度脂肪分数, 肝脏硬度检测, 受控衰减参数, 儿童, 诊断

Abstract: Objective This study was conducted to investigate application of magnetic resonance proton density fat fraction (MRI-PDFF) in predicting nonalcoholic steatohepatitis (NASH) in overweight and obese children with nonalcoholic fatty liver disease (NAFLD). Methods 74 overweight and 28 obese children with NAFLD were enrolled in 903^rd Hospital, Jiangyou, between December 2022 and December 2023, and all underwent liver biopsies for diagnosis of NASH. MRI-PDFF was obtained by MRI scan, liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were determined by Fibroscan and area under receiver operating characteristic (AUC) was applied to predict diagnostic performance. Results Of the 102 overweight/obese children, histo-pathological examination diagnose simple nonalcoholic fatty liver (SNFL) in 75 cases and NASH in 27 cases; basic mass index, serum ALT, AST, TG, MRI-PDFF, LSM and CAP in children with NASH were (32.2±3.4)kg/m², (92.7±31.3)U/L, (96.8±34.1)U/L, (3.1±1.2)mmol/L, (12.5±4.7)%, (11.7±1.4)kPa and (370.4±146.9)dB/m, all significantly different compared to[(26.7±2.2)kg/m², (38.2±4.4)U/L, (33.0±3.4)U/L, (2.3±0.7)mmol/L, (7.7±2.0)%, (6.2±1.0)kPa and (262.3±61.2)dB/m, respectively, P<0.05)] in those with SNFL; percentages of overweight and obese in children with NASH were 37.0% and 63.0%, much different compared to 85.3% and 14.7% in those with SNFL (P<0.05); ROC analysis showed that the AUC was 0.87(95%CI:0.80-0.93), with sensitivity (Se) of 81.5% and specificity (Sp) of 85.3%, when MRI-PDFF was 11.9% as the cut-off-value in predicting NASH, while the AUC was 0.81(95%CI:0.78-0.89), with Se of 85.2% and Sp of 58.7% (P<0.05), when LSM was 10.8 kPa and CAP was 310.5dB/m combination as the cut-off-value. Conclusion The diagnostic performance of MRI-PDFF in predicting NASH in overweight/obese children with NAFLD is satisfactory, and from the economic and convenient point of view, we recommend Fibroscan for screening.

Key words: Nonalcoholic steatohepatitis, Magnetic resonance imaging, Proton density fat fraction, Fibroscan, Children, Diagnosis

罗洪霞, 李静秋, 李媛媛, 冯国隽, 余霞. 超重/肥胖非酒精性脂肪性肝病儿童磁共振质子密度脂肪分数检测意义研究^*[J]. 实用肝脏病杂志, 2024, 27(4): 527-530.

Luo Hongxia, Li Jingqiu, Li Yuanyuan, et al. Magnetic resonance proton density fat fraction in overweight/obese children with nonalcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2024, 27(4): 527-530.

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超重/肥胖非酒精性脂肪性肝病儿童磁共振质子密度脂肪分数检测意义研究^*

Magnetic resonance proton density fat fraction in overweight/obese children with nonalcoholic fatty liver disease

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