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磁共振质子密度脂肪分数和瞬时弹性成像对慢性乙型肝炎患者肝脂肪含量的定量评估价值

杨逸铭 刘玉品 黄丽霞 陈志远 欧阳舒曼 彭静

引用本文:
Citation:

磁共振质子密度脂肪分数和瞬时弹性成像对慢性乙型肝炎患者肝脂肪含量的定量评估价值

DOI: 10.3969/j.issn.1001-5256.2021.12.013
基金项目: 

广东省中医药局科研项目 (20202072)

2019年度广东省中医院院内专项(青年项目) (YN2019QL09)

详细信息
    通信作者:

    刘玉品,1034069077@qq.com

  • 中图分类号: R512.62; R575.5

Value of magnetic resonance imaging-proton density fat fraction and FibroScan in quantitative evaluation of liver fat content in patients with chronic hepatitis B

Research funding: 

Project of Administration of Traditional Chinese Medicine of Guangdong Province of China (20202072);

Special Project of Guangdong Provincial Hospital of Traditional Chinese Medicine in 2019 (Youth Project) (YN2019QL09)

  • 摘要:   目的  探讨磁共振质子密度脂肪分数(MRI-PDFF)和瞬时弹性成像(FibroScan)定量评估慢性乙型肝炎(CHB)患者肝脂肪含量的价值。  方法  选取2017年2月—2020年7月于广州中医药大学第二临床医学院肝病科住院CHB患者96例,所有患者均接受肝组织病理检查确诊,并于术前完善MRI-PDFF、FibroScan检查。根据穿刺结果,将所有患者无脂肪肝(n=44)、轻度脂肪肝(n=33)及中重度脂肪肝(n=19)分组。符合正态分布的计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t法;不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验,并进行Bonferroni校正。采用受试者工作特征曲线(ROC曲线)分析HFF及CAP诊断脂肪肝的曲线下面积(AUC),获得敏感度、特异度和阈值。采用组内相关系数检验MRI-PDFF数据的一致性。  结果  中重度脂肪肝组MRI-PDFF HFF较无脂肪肝组、轻度脂肪肝组明显升高(P值均<0.05),轻度脂肪肝组MRI-PDFF HFF较无脂肪肝组明显升高(P<0.05)。中重度脂肪肝组FibroScan CAP较无脂肪肝组、轻度脂肪肝组均明显升高(P值均<0.05);轻度脂肪肝组FibroScan CAP较无脂肪肝组明显升高(P<0.05)。MRI-PDFF HFF诊断轻度脂肪肝的阈值为5.1%,AUC为0.901(P<0.001),敏感度为90.9%,特异度为82.7%;诊断中重度脂肪肝阈值为9.7%,AUC为0.972(P<0.001),敏感度为96.1%,特异度为89.5%。FibroScan CAP诊断轻度脂肪肝的阈值为258.5 dB/m,AUC为0.829(P<0.001),敏感度为77.3%,特异度为78.8%;诊断中重度脂肪肝阈值为285.5 dB/m,AUC为0.830(P<0.001),敏感度为76.6%,特异度为78.9%。  结论  MRI-PDFF、FibroScan能够客观评价CHB患者脂肪肝程度,MRI-PDFF HFF、FibroScan CAP可作为定量分析CHB合并肝脂肪变性的无创性标志物,并且MRI-PDFF HFF具有更高的诊断效能。

     

  • 图  1  MRI-PDFF肝脂肪比检查结果

    图  2  MRI-PDFF HFF和FibroScan CAP评价轻度脂肪肝的ROC曲线

    图  3  MRI-PDFF HFF和FibroScan CAP评价中重度脂肪肝的ROC曲线

    表  1  各级脂肪肝组MRI-PDFF HFF、FibroScan CAP比较

    组别 例数 MRI-PDFF HFF FibroScan CAP
    无脂肪肝组 44 3.78(3.37~4.73) 231.16±45.27
    轻度脂肪肝组 33 5.67(4.60~7.06)1) 279.15±42.641)
    中重度脂肪肝组 19 17.91(11.12~22.71)1)2) 316.31±39.411)2)
    统计值 H=59.99 F=28.56
    P <0.001 <0.001
    注:与无脂肪肝组比较,1) P<0.05;与轻度脂肪肝组比较,2)P<0.05。
    下载: 导出CSV

    表  2  MRI-PDFF HFF一致性检验结果

    项目 组内相关性 95%CI 使用Ture值0进行F值测试
    数值 df1 df2 显著性
    单一测量 0.981 0.972~0.988 108.126 95 95 <0.001
    平均值测量 0.991 0.986~0.994 108.126 95 95 <0.001
    下载: 导出CSV
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  • 收稿日期:  2021-04-06
  • 录用日期:  2021-05-19
  • 出版日期:  2021-12-20
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