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

doi:10.3969/j.issn.1001-5256.2021.12.013

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

广州中医药大学第二临床医学院/广东省中医院影像科，广州 510120

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
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出版历程
- 收稿日期: 2021-04-06
- 录用日期: 2021-05-19
- 出版日期: 2021-12-20

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

Department of Radiology, The Second Clinical Medical College of Guangzhou University of Chinese Medicine & Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangdong 510210, China

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

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。
- 乙型肝炎，慢性 /
- 脂肪肝 /
- 磁共振质子密度脂肪分数 /
- 弹性成像技术
Abstract: Objective To investigate the value of magnetic resonance imaging-proton density fat fraction (MRI-PDFF) and FibroScan in the quantitative evaluation of liver fat content in patients with chronic hepatitis B (CHB). Methods A total of 96 patients with CHB who were hospitalized in Department of Hepatology, The Second Clinical Medical College of Guangzhou University of Chinese Medicine, from February 2017 to July 2020 were enrolled, and all patients were diagnosed based on liver pathological examination. MRI-PDFF and FibroScan were performed before surgery. According to the results of liver biopsy, the patients were divided into non-fatty liver disease group with 44 patients, mild fatty liver disease group with 33 patients, and moderate-to-severe fatty liver disease group with 19 patients. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups; Bonferroni correction was also performed. The receiver operating characteristic (ROC) curve was plotted to analyze the area under the ROC curve (AUC) of hepatic fat fraction (HFF) and controllable attenuation parameters (CAP) in the diagnosis of fatty liver disease and obtain their sensitivities, specificities, and optimal cut-off values. The intraclass correlation coefficient was used to investigate the consistency of MRI-PDFF data. Results The moderate-to-severe fatty liver disease group had a significant increase in MRI-PDFF HFF compared with the non-fatty liver disease group and the mild fatty liver disease group (all P < 0.05), and the mild fatty liver disease group had a significant increase in MRI-PDFF HFF compared with the non-fatty liver disease group(P < 0.05). The moderate-to-severe fatty liver disease group had a significant increase in FibroScan CAP compared with the non-fatty liver disease group and the mild fatty liver disease group (all P < 0.05), and the mild fatty liver disease group had a significant increase in FibroScan CAP compared with the non-fatty liver disease group (P < 0.05). In the diagnosis of mild fatty liver disease, MRI-PDFF HFF had an AUC of 0.901 (P < 0.001), a sensitivity of 90.9%, and a specificity of 82.7% at the optimal cut-off value of 5.1%, and in the diagnosis of moderate-to-severe fatty liver disease, MRI-PDFF HFF had an AUC of 0.972 (P < 0.001), a sensitivity of 96.1%, and a specificity of 89.5% at the optimal cut-off value of 9.7%. In the diagnosis of mild fatty liver disease, FibroScan CAP had an AUC of 0.829 (P < 0.001), a sensitivity of 77.3%, and a specificity of 78.8% at the optimal cut-off value of 258.5 dB/m, and in the diagnosis of moderate-to-severe fatty liver disease, FibroScan CAP had an AUC of 0.830 (P < 0.001), a sensitivity of 76.6%, and a specificity of 78.9% at the optimal cut-off value of 285.5 dB/m. Conclusion Both MRI-PDFF and FibroScan can objectively evaluate the degree of fatty liver disease in patients with CHB. MRI-PDFF HFF and FibroScan CAP can be used as noninvasive markers for the quantitative analysis of CHB with hepatic steatosis, and MRI-PDFF HFF tends to have higher diagnostic efficiency.
- Hepatitis B, Chronic /
- Fatty Liver /
- Magnetic Resonance Imaging Proton Density Fat Fraction /
- Elasticity Imaging Techniques

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图 1 MRI-PDFF肝脂肪比检查结果

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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值		＜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
项目	组内相关性	95%CI	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

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