MRI R2^(*)值在非酒精性脂肪性肝病患者肝纤维化分期评估中的最佳阈值探讨

Study on the best threshold of R2^(*) value of MRI in the staging evaluation of liver fibrosis in patients with nonalcoholic fatty liver disease

目的研究MRI R2^(*)值在非酒精性脂肪性肝病(NAFLD)患者肝纤维化分期评估中的最佳阈值。方法回顾性分析2017年12月到2019年12月84例在安阳市人民医院接受检查并诊断为NAFLD患者的临床资料,按照其穿刺活检后的结果分为S1期组(汇管区纤维化增广,但只局限于窦周及小叶内,n=23)、S2期组(汇管区周围纤维化,有间隔形成,但小叶结构仍然完整,n=24)、S3期组(小叶结构被破坏,但无肝硬化,n=27)、S4期组(早期肝硬化,n=10);均通过MRI扫描获取R2*测量值,并对四组R2*测量值进行比较;利用ROC曲线分析R2^(*)值预测NAFLD患者肝纤维化S2、S3、S4期的价值。结果比较R2*测量结果S2、S4组>S3组>S1组,差异较为显著(P<0.05)。经ROC分析R2*值预测S2、S3、S4组的曲线下面积分别为0.748、0.663、0.790。结论R2*值对评价NAFLD患者肝纤维化程度存在一定预测价值,但对中重度肝纤维化的预测需进一步研究进行证实。

Objective To study the best threshold value of MRI R2*in the staging evaluation of liver fibrosis in patients with nonalcoholic fatty liver disease(NAFLD).Methods The clinical data of 84 patients diagnosed as NAFLD in our hospital from December 2017 to December 2019 were analyzed retrospectively.According to the results of biopsy,the patients were divided into S1 group(increased fibrosis in the portal area,but only confined to the peri-sinusoid and lobule,n=23),S2 group(fibrosis around the portal area,with septal formation,but lobule structure is still intact,n=24),S3group(lobule structure is damaged,but no cirrhosis,n=27),S4 group(early cirrhosis,n=10);R2*values were obtained by MRI scanning and compared among the four groups.ROC curve was used to analyze R2*value to predict S2,S3 and S4stages of liver fibrosis in NAFLD patients.Results The results of R2*were compared between S2 group and S4 group(P<0.05).ROC analysis of R2*predicted that the area under the curve of S2,S3 and S4 groups were 0.748,0.663 and0.790 respectively.Conclusion R2*value has a certain predictive value to evaluate the degree of liver fibrosis in NAFLD patients,but the prediction of moderate and severe liver fibrosis needs further study.