切换至 "中华医学电子期刊资源库"
高级检索
中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (07) : 503 -508. doi: 10.3877/cma.j.issn.1674-0785.2021.07.005

临床研究

代谢相关脂肪性肝病患者MRI-PDFF分布特点
陆玮婷1, 史会连1, 陈沁磊1, 武建海2, 刘绍伟3, 乔飞1,†()   
  1. 1. 210029　南京，江苏省中医院感染科
    2. 210029　南京，江苏省中医院营养科
    3. 210029　南京，江苏省中医院放射科
  • 收稿日期:2021-04-18 出版日期:2021-07-15
  • 通信作者: 乔飞
  • 基金资助:
    江苏省中医院院级课题(Y2018CX09)

Characteristics of magnetic resonance imaging proton density fat fraction in patients with metabolic associated fatty liver disease

Weiting Lu1, Huilian Shi1, Qinlei Chen1, Jianhai Wu2, Shaowei Liu3, Fei Qiao1,†()   

  1. 1. Department of Infectious Diseases, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China
    2. Department of Nutrition, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China
    3. Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China
  • Received:2021-04-18 Published:2021-07-15
  • Corresponding author: Fei Qiao
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陆玮婷, 史会连, 陈沁磊, 武建海, 刘绍伟, 乔飞. 代谢相关脂肪性肝病患者MRI-PDFF分布特点[J/OL]. 中华临床医师杂志(电子版), 2021, 15(07): 503-508.

Weiting Lu, Huilian Shi, Qinlei Chen, Jianhai Wu, Shaowei Liu, Fei Qiao. Characteristics of magnetic resonance imaging proton density fat fraction in patients with metabolic associated fatty liver disease[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(07): 503-508.

目的

探讨代谢相关脂肪性肝病（MAFLD）患者磁共振成像评估质子密度脂肪分数（MRI-PDFF）分布特点及其与腹围、臀围、体质量指数（BMI）及肝功能的关系。

方法

收集2018年1月至2020年4月江苏省中医院感染科门诊超声诊断为MAFLD的患者171例，行磁共振成像3.0上腹部平扫加MRI-PDFF测定，并进行身高、体质量、腹围、臀围以及丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（GGT）水平检测。

结果

171例MAFLD患者肝脏MRI-PDFF平均值为（13.76±10.30）%。随着肝脏脂肪含量的增高，患者的腹围、臀围、BMI以及肝功能水平也逐渐增高，不同程度的MRI-PDFF患者中，腹围（F=4.050，P=0.008）、臀围（F=3.449，P=0.018）、BMI（F=3.552，P=0.016）及ALT（H=27.904，P＜0.001）、AST（H=25.070，P＜0.001）、GGT（H=24.039，P＜0.001）水平均有统计学差异。相关性分析显示，MRI-PDFF与ALT（r=0.459，P＜0.001）、AST（r=0.436，P＜0.001）呈中度正相关，而与BMI相关性极低（r=0.149，P=0.052）。

结论

MRI-PDFF作为一种无创的、可定量测定肝脏脂肪含量的方法，能较为准确地反映肝脏的脂肪含量，适用于肝脏脂肪含量的动态评估及疗效监测。

关键词: 磁共振成像, 质子密度脂肪分数, 代谢相关脂肪性肝病
Objective

To investigate the characteristics of magnetic resonance imaging proton density fat fraction (MRI-PDFF) in patients with metabolic associated fatty liver disease (MAFLD) and analyze the relationship of MRI-PDFF with abdominal circumference, hip circumference, body mass index (BMI), and liver function.

Methods

A total of 171 infectious outpatients with MAFLD at Jiangsu Province Hospital of Chinese Medicine were recruited from January 2018 to April 2020. The MRI-PDFF, height, weight, abdominal circumference, hip circumference, and serum indexes of liver function (ALT, AST, ALP, and GGT) in all patients were tested.

Results

The MRI-PDFF of the 171 patients was (13.79±10.32) %. As the liver fat content increased, the patients' abdominal circumference, hip circumference, BMI, and liver function levels also gradually increased. The abdominal circumference (F=4.050, P=0.008), hip circumference (F=3.449, P=0.018), BMI (F=3.552, P=0.016), ALT (H=27.904, P＜0.001), AST (H=25.070, P＜0.001), GGT (H=24.039, P＜0.001) differed significantly among different levels of MRI-PDFF. Correlation analysis showed that liver MRI-PDFF was moderately related to ALT (r=0.459, P＜0.001) and AST (r=0.436, P＜0.001), but had a very low correlation with BMI (r=0.149, P=0.052).

Conclusion

MRI-PDFF as a non-invasive and quantitative method can accurately reflect liver fat content, and is suitable for dynamic evaluation of liver fat content and monitoring of treatment effect.

Key words: Magnetic resonance imaging, Proton density fat fraction, Metabolic associated fatty liver disease
图1 磁共振成像3.0测定肝脏质子密度脂肪分数图像
表1 不同BMI患者的腹围、臀围、MRI-PDFF及肝功能指标比较
组别 例数 腹围（cm，
x¯
±s）		 臀围（cm，
x¯
±s）		 MRI-PDFF（%，
x¯
±s）		 ALT［U/L，M（P25，P75）］ AST［U/L，M（P25，P75）］ ALP（U/L，
x¯
±s）		 GGT［U/L，M（P25，P75）］
正常组 13 80.5±3.91 91.79±1.51 10.56±10.98 36（22.00，75.00） 31（22.50，49.00） 83.38±30.92 34（20.00，45.50）
超重组 118 90.80±6.17 99.68±3.85 13.11±9.98 54（31.25，87.75） 35.5（26.25，56.00） 74.47±21.07 44.5（23.25，80.75）
肥胖组 40 111.35±2.34 110.11±4.93 16.72±10.64 75.5（46.25，135.25） 43.5（31.25，58.75） 77.85±21.33 48.5（27.25，66.75）
统计值 F=54.001 F=142.100 F=2.565 H=10.720 H=4.070 F=1.158 H=1.759
P值 ＜0.001 ＜0.001 0.080 0.005 0.131 0.317 0.415
表2 不同程度MRI-PDFF患者的腹围、臀围、BMI及肝功能指标比较
组别 例数 腹围（cm，
x¯
±s）		 臀围（cm，
x¯
±s）		 BMI（kg/m2，
x¯
±s）		 ALT［U/L，M（P25，P75）］ AST［U/L，M（P25，P75）］ ALP（U/L，
x¯
±s）		 GGT［U/L，M（P25，P75）］
正常组 49 89.17±8.47 99.05±5.64 25.97±2.88 44（26.00，60.00） 29（25.00，42.00） 76.85±20.51 27（19.0，48.0）
轻度脂肪肝组 29 94.35±9.31 102.12±7.07 27.91±4.08 45（28.50，83.00） 30（24.50，51.00） 75.6±21.03 40（20.0，104.0）
中度脂肪肝组 65 98.91±21.19 102.55±6.77 28.07±4.16 65（34.50，98.00） 42（30.00，55.50） 76.05±23.27 48（28.5，66.5）
重度脂肪肝组 28 95.73±9.25 102.83±6.09 27.68±2.87 101（63.50，159.25） 59（42.25，89.50） 74.46±23.53 76.5（54.5，117.0）
统计值 F=4.050 F=3.449 F=3.552 H=27.904 H=25.070 F=0.071 H=24.039
P值 0.008 0.018 0.016 ＜0.001 ＜0.001 0.976 ＜0.001
表3 MAFLD患者MRI-PDFF与BMI、腹围、臀围及肝功能指标的相关性分析
项目 BMI 腹围 臀围 ALT AST ALP GGT
r值 0.149 0.167 0.178 0.459 0.436 -0.021 0.306
P值 0.052 0.029 0.020 ＜0.001 ＜0.001 0.788 ＜0.001
图2 MAFLD患者MRI-PDFF与ALT、AST的相关性分析散点图。图a为MRI-PDFF与ALT的相关性分析；图b为MRI-PDFF与AST的相关性分析
10
Karlas T, Petroff D, Sasso M, et al. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis [J]. J Hepatol, 2017, 66(5): 1022-1030.
11
Xu L, Lu W, Li P, et al. A comparison of hepatic steatosis index, controlled attenuation parameter and ultrasound as noninvasive diagnostic tools for steatosis in chronic hepatitis B [J]. Dig Liver Dis, 2017, 49(8): 910-917.
12
Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease—meta analytic assessment of prevalence, incidence, and outcomes [J]. Hepatology, 2016, 64(1): 73-84.
13
Younossi ZM, Blissett D, Blissett R, et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe [J]. Hepatology, 2016, 64(5): 1577-1586.
14
Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2015 annual data report: liver [J]. Am J Transplant, 2017, 17(1): 174-251.
15
Marrero JA. Obesity and liver disease: the new era of liver transplantation [J]. Hepatology, 2019, 70(2): 459-461.
16
Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease [J]. J Hepatol, 2008, 49(4): 608-612.
17
Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease [J]. Gastroenterology, 2015, 149(2): 389-397.
18
Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up [J]. Hepatology, 2015, 61(5): 1547-1554.
19
European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis [J]. J Hepatol, 2015, 63(1): 237-264.
20
Lindenmeyer CC, McCullough AJ. The natural history of nonalcoholic fatty liver disease- an evolving view [J]. Clin Liver Dis, 2018, 22(1): 11-21.
21
Zelber-Sagi S, Lotan R, Shlomai A, et al. Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up [J]. J Hepatol, 2012, 56(5): 1145-1151.
22
Kim M, Kang BK, Jun DW, et al. Comparison of conventional sonographic signs and magnetic resonance imaging proton density fat fraction for assessment of hepatic steatosis [J]. Sci Rep, 2018, 8(1): 7759.
23
Loomba R, Kayali Z, Noureddin M, et al. GS-0976 reduces hepatic steatosis and fibrosis markers in patients with nonalcoholic fatty liver disease [J]. Gastroenterology, 2018, 155(5): 1463-1473.
24
杨逸铭, 刘玉品, 周懂晶, 等. 3.0T MRI PDFF和IP-OP对脂肪肝定量评估的价值 [J]. 吉林大学学报(医学版), 2020, 46(4): 875-879.
25
Wang J, Ou H, Yen Y, et al. Usefulness of controlled attenuation parameter in detecting and monitoring hepatic steatosis with MRIPDFF as reference [J]. Dig Dis Sci, 2020, 65(5): 1512-1519.
26
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 [J]. Eur Radiol, 2019, 29(7): 3564-3573.
27
Jeffrey BS, Michael SM, Behling C, et al. Magnetic resonance imaging and liver histology as biomarkers of hepatic steatosis in children with nonalcoholic fatty liver disease [J]. Hepatology, 2015, 61(5): 1887-1895.
28
Cyrielle C, Reeder S,Sirlin C,et al. Noninvasive,quantitative assessment of liver fat by MRI-PDFF as an endpoint in NASH trials [J]. Hepatology, 2018, 68(2): 763-772.
29
Janki P, Ricki B, Jeffrey C, et al. Association of noninvasive quantitative decline in liver fat content on MRI with histologic response in nonalcoholic steatohepatitis [J]. Therap Adv Gastroenterol, 2016, 9(5): 692-701.
1
Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement [J]. J Hepatol, 2020, 73(1): 202-209.
2
Alexander J, Torbenson M, Wu TT, et al. Non-alcoholic fatty liver disease contributes to hepatocarcinogenesis in non-cirrhotic liver: a clinical and pathological study [J]. J Gastroenterol Hepatol, 2013, 28(5): 848-854.
3
Zuberbuhler F, Boursier J. Noninvasive diagnosis of liver fibrosis in NAFLD: Tips tricks [J]. Clin Res Hepatol Gastroenterol, 2019, 43(6): 658-662.
4
Sanches PL, De Piano A, Campos RM, et al. Association of nonalcoholic fatty liver disease with cardiovascular risk factors in obese adolescents: the role of interdisciplinary therapy [J]. J Clin Lipidol, 2014, 8(3): 265-272.
5
Keitaro S, Achille M, Brian M, et al. Interexamination repeatability and spatial heterogeneity of liver iron and fat quantification using MRI-based multistep adaptive fitting algorithm [J]. J Magn Reson Imaging, 2015, 42(5): 1281-1290.
6
Middleton MS, Natta ML, Heba ER,et al. Diagnostic accuracy of magnetic resonance imaging hepatic proton density fat fraction in pediatric nonalcoholic fatty liver disease [J]. Hepatology, 2018, 67(3): 858-872.
7
Reeder SB. Emerging quantitative magnetic resonance imaging biomarkers of hepatic steatosis [J]. Hepatology, 2013, 58(6): 1877-1880.
8
Chen G, Jiang J, Wang X, et al. Evaluation of hepatic steatosis before liver transplantation in ex vivo by volumetric quantitative PDFF-MRI [J]. Magn Reson Med, 2020, 85(5): 2805-2814.
9
中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版) [J]. 临床肝胆病杂志, 2018, 34(5): 947-957.
[1] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(05): 470-476.
[2] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[3] 庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[4] 吴少敏, 张世豪, 刘炳光, 李婵, 尹嘉敏, 郑昌业, 黄素然. 胎儿巨大蛛网膜囊肿并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 390-397.
[5] 王莉, 曹蕾, 王亚丹, 张伟. Krabbe病1例临床分析并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 339-345.
[6] 陈海香, 王元银, 蒋盼. 冠突过长患者的临床表现及磁共振影像学分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 169-174.
[7] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[8] 刘明辉, 葛方明. MRI 对腹股沟疝修补术后患者早期并发症的评估价值研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 579-583.
[9] 臧书芹, 陈巧玲, 江思源, 朱晓明, 沈浮, 王颢, 张卫, 邵成伟. 基于直肠高分辨MRI的直肠侧系膜分析及其临床价值的研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 312-320.
[10] 吴浩凡, 刘元豪, 张锋敏, 张现中, 朱金浩, 黄嘉莹, 刘忠臣, 丁良福, 庄成乐. 基于术前MRI的盆底解剖参数对超低位直肠癌精准功能保肛手术时间的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(03): 209-216.
[11] 张立俊, 孙存杰, 胡春峰, 孟冲, 张辉. MSCT、DCE-MRI 评估术前胃癌TNM 分期的准确性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 519-523.
[12] 陈利, 杨长青, 朱风尚. 重视炎症性肠病和代谢相关脂肪性肝病间的串话机制研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 385-389.
[13] 姜超, 夏旭东, 王功夏, 何向宇, 王海彬, 李媛. 磁共振DWI及其ADC对乳腺导管原位癌伴微浸润腋窝淋巴结转移的诊断价值[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 234-243.
[14] 欧阳川, 朱巧珍, 欧阳林. 腰椎间盘退变的生物代谢特征及评价技术研究进展[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 206-211.
[15] 金安松, 邹玉松, 刘玖涛, 薛凤麟, 庞爱兰. 孤立性颅内浆细胞瘤一例及相关文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 495-500.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号