非酒精性脂肪性肝病患者磁共振质子密度脂肪分数变化

doi:10.3969/j.issn.1672-5069.2021.03.014

摘要/Abstract

摘要： 目的分析非酒精性脂肪性肝病(NAFLD)患者MRI检查质子密度脂肪分数(MRI-PDFF)变化。方法 2018年1月～2020年9月我院诊治的NAFLD患者64例,均接受超声、肝活检和MRI检查,测量PDFF。结果在64例NAFLD患者中,超声诊断轻、中和重度NAFLD患者分别为20例、28例和16例;重度患者体质指数(BMI)、血脂、空腹血糖和MRI-PDFF水平显著高于轻度和中度患者(P<0.05);肝组织学诊断无脂肪变(S0)8例、S1 22例、S2 25例和S3 9例,其MRI-PDFF分别为(3.2±1.4)%、(8.7±6.3)%、(15.4±5.0)%和(22.8±7.4)%,差异显著(P<0.05);诊断肝组织炎症G1、G2和G3级分别为14例、36例和14例,其MRI-PDFF分别为(8.6±7.5)%、(10.9±9.8)%和(14.6±11.3)%,差异显著(P<0.05);诊断肝纤维化F0期18例、F1期24例、F2期14例、F3期6例和F4期2例,其MRI-PDFF分别为(4.6±3.2)%、(9.4±8.1)%、(10.6±7.4)%、(11.3±10.6)%和(7.1±3.4)%,差异显著(P<0.05)。结论不同肝脂肪变程度NAFLD患者MRI-PDFF值具有显著性差异,应用MRI-PDFF检测可能具有量化评价NAFLD患者肝脂肪变程度的临床意义,值得进一步研究。

关键词: 非酒精性脂肪性肝病, 磁共振质子密度脂肪分数, 肝脂肪变, 诊断

Abstract: Objective The paper aimed to analyze the clinical implication of magnetic resonance imaging-proton density fat fraction (MRI-PDFF) in patients with nonalcoholic fatty liver diseases (NAFLD).Methods 64 patients with NAFLD were enrolled in our hospital between January 2018 and September 2020, and all underwent sonography, liver biopsies and MRI scan. The MRI-PDFF was obtained.Results Out of the 64 patients with NAFLD, the sonography showed mild, moderate and severe fatty liver in 20 cases, 28 cases and 16 cases, and the body mass index, blood fats, fasting blood glucose levels and MRI-PDFF in patients with severe fatty liver were all significantly higher than those in patients with mild or moderate fatty liver (P<0.05); the liver histopathological examination demonstrated no liver tissue steatosis (S0) , S1, S2 and S3 in 8 cases, 22 cases, 25 cases and 9 cases, with the MRI-PDFF of (3.2±1.4)%, (8.7±6.3)%, (15.4±5.0)% and (22.8±7.4)%, respectively, significantly different among them (P<0.05), the liver active inflammation grading (G)1 , G2 and G3 were in 14 cases, 36 cases and 14 cases, with the MRI-PDFF of (8.6±7.5)%, (10.9±9.8)% and (14.6±11.3)%, significantly different among them (P<0.05), and the liver fibrosis (F)0 in 18 cases, F1 in 24 cases, F2 in 14 cases, F3 in 6 cases and F4 in 2 cases, with the MRI-PDFF of being (4.6±3.2)%, (9.4±8.1)%, (10.6±7.4)%, (11.3±10.6)% and (7.1±3.4)%, significantly different among them (P<0.05).Conclusion The MRI-PDFF changes and significantly different in patients with different degree of fatty liver, which might help the early diagnosis of patients with hepatic steatosis easily.

Key words: Nonalcoholic fatty liver disease, Magnetic resonance imaging-proton density fat fraction, Hepatic steatosis, Diagnosis

贾群玲, 徐志宾, 韩舒. 非酒精性脂肪性肝病患者磁共振质子密度脂肪分数变化[J]. 实用肝脏病杂志, 2021, 24(3): 359-362.

Jia Qunling, Xu Zhibin, Han Shu. Implication of magnetic resonanceimaging-proton density fat fraction in patients with nonalcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2021, 24(3): 359-362.

参考文献

[1] Xiao G, Zhu S, Xiao X, et al. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Hepatology, 2017, 66(5):1486-1501.
[2]Kwok R, Choi KC, Wong GL, et al. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut, 2016, 65(8):1359-1368.
[3] 徐亮, 钟燕, 苏淑婷, 等. 反应性氧化物、脂联素在慢性乙型肝炎病毒感染合并非酒精性脂肪性肝病中的研究. 中华肝脏病杂志, 2020, 28(3): 247-253.
[4] Di N, Zhou X, Chen Y, et al. Could semiquantitative analysis of real-time ultrasound elastography distinguish more liver parenchyma alterations of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome?. Arch Endocrinol Metab, 2019, 63(2):128-136.
[5] Zhang S, Gu Y, Wang L, et al. Association between dietary raw garlic intake and newly diagnosed nonalcoholic fatty liver disease: a population-based study. Eur J Endocrinol, 2019, 181(6):591-602.
[6] Zheng J, Zhou Y, Zhang K, et al. Association between nonalcoholic fatty liver disease and subclinical atherosclerosis: a cross-sectional study on population over 40 years old. BMC Cardiovasc Disord, 2018, 18(1):147.
[7] Chen LZ, Xin YN, Geng N, et al. PNPLA3 I148M variant in nonalcoholic fatty liver disease: demographic and ethnic characteristics and the role of the variant in nonalcoholic fatty liver fibrosis. World J Gastroenterol, 2015, 21(3):794-802.
[8] Qin S, Wang S, Wang X, et al. Liver stiffness assessed by transient elastographyas a potential indicator of chronic kidney disease in patients with nonalcoholic fatty liver disease. J Clin Lab Anal, 2019, 33(2):e22657.
[9] 瞿欢佳, 王磊, 金沛桦, 等. 氢质子磁共振波谱在脂肪性肝病肝脏甘油三酯含量测定中的价值和其影响因素. 中华肝脏病杂志, 2017, 25(11): 858-863.
[10] Jayakumar S, Middleton MS, Lawitz EJ, et al. Longitudinal correlations between MRE, MRI-PDFF,and liver histology in patients with non-alcoholic steatohepatitis: Analysis of data from a phase II trial of selonsertib. J Hepatol, 2019, 70(1):133-141.
[11] Park CC, Hooker C, Hooker JC, et al. Assessment of a high-SNR chemical-shift-encoded MRI with complex reconstruction for proton density fat fraction (PDFF) estimation overall and in the low-fat range. J Magn Reson Imaging, 2019, 49(1):229-238.
[12] Wang JH, Ou HY, Yen YH, et al. Usefulness of controlled attenuation parameter in detecting and monitoring hepatic steatosis with MRI-PDFF as reference. Dig Dis Sci, 2020, 65(5):1512-1519.
[13] Yan J, Yao B, Kuang H, et al. Liraglutide, sitagliptin, and insulin glargine added to metformin: the effect on body weight and intrahepatic lipid in patients with type 2 diabetes mellitus and nonalcoholic fatty liver disease. Hepatology, 2019, 69(6):2414-2426.
[14] 中华医学会肝病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南. 中华糖尿病杂志, 2010, 2(1): 15-19.
[15] Liu J, Wang T, He K, et al. Cardiolipin inhibitor ameliorates the non-alcoholic steatohepatitis through suppressing NLRP3 inflammasome activation. Eur Rev Med Pharmacol Sci, 2019,23(18):8158-8167.
[16] 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪肝专家委员会. 非酒精性脂肪性肝病防治指南(2018年版). 实用肝脏病杂志, 2018, 21(2):177-186.
[17] Liao R, Fu YP,Wang T, et al. Metavir and FIB-4 scores are associated with patient prognosis after curative hepatectomy in hepatitis B virus-related hepatocellular carcinoma:a retrospective cohort study at two centers in China. Oncotarget, 2017, 8(1): 1774-1781.
[18] Tang A,Tan J, Sun M, et al. Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology, 2013, 267(2): 422431.
[19] Wildman-Tobriner B, Middleton MM, Moylan CA, et al. Association between magnetic resonance imaging-proton density fat fraction and liver histology features in patients with nonalcoholic fatty liver disease or nonalcoholic steatohepatitis. Gastroenterology, 2018, 155(5):1428-1435.e2.
[20] Gu J, Liu S, Du S, et al. Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: a meta-analysis. Eur Radiol, 2019, 29(7):3564-3573.
[21] Schwimmer JB, Middleton MS, Behling C, et al. Magnetic resonance imaging and liver histology as biomarkers of hepatic steatosis in children with nonalcoholic fatty liver disease. Hepatology, 2015, 61(6):1887-1895.
[22] Middleton MS, Van Natta ML, Heba ER, et al. Diagnostic accuracy of magnetic resonance imaging hepatic proton density fat fraction in pediatric nonalcoholic fatty liver disease. Hepatology, 2018, 67(3):858-872.
[23] Caussy C, Alquiraish MH, Nguyen P, et al. Optimal threshold of controlled attenuation parameter with MRI-PDFF as the gold standard for the detection of hepatic steatosis. Hepatology, 2018, 67(4):1348-1359.