磁共振氢谱和CT在非酒精性脂肪性肝病中的对比应用

The application of proton magnetic resonance spectroscopy and computerized tomography in evaluating nonalcoholic fatty liver disease

目的应用磁共振氢谱（^1HMRS）技术和CT定量诊断非酒精性脂肪性肝病（NAFLD）。方法按中华医学会NAFLD诊断标准诊断，NAFLD患者22例（NAFLD组），并以20名健康人为对照组。两组均进行常规体检、肝脏^1HMRS扫描和CT平扫，计算肝内脂质含量（IHCL）和CT检测的肝／脾比值，应用SPSS软件包进行多因素相关性分析、独立样本t检验。结果NAFLD组体重指数、腰臀比、ALT、甘油三酯、尿酸和IHCL较正常组明显升高，分别为（28．4±2．4）kg／m^2、0．914±0．04、（71．5±24．8）U／L、（2．48±1．46）mmol／L、（420．7±57．5）umol／L、27．49％±12．27％对比（21．74±2．2）kg／m^2、0．83±0．04、（20．4±10．1）U／L、（372．1±50．6）umol／L、1．34％±0．79％，P值分别〈0．01或〈0．05；肝／脾比值较正常组明显下降（0．69±0．24对比1．21±0．14，P〈0．01）。但IHCL、肝／脾比值和上述指标之间没有明显的相关性，IHCL和肝／脾比值呈负相关。结论肝脏^1HMRS扫描可对肝脏内脂质含量进行准确定量，在非酒精性脂肪性肝病的定量诊断上优于CT平扫。

Objective To investigate the application of proton magnetic resonance spectroscopy （^1HMRS） and computerized tomography （CT） in evaluating nonalcoholic fatty liver disease （NAFLD）. Methods Twenty-two NAFLD patients were selected, according to the Chinese Medical Association standard, and compared with 20 healthy persons （as the control group）. Their body mass index （BMI）, waist to hip ratio （WHR）, and blood pressure （BP） were examined. The serum ALT, the concentration of fasting blood glucose （FBG）, total cholesterol （TC）, triglyceride （TG）, and uric acid （UA） were tested simultaneously. The severity of hepatosteatosis was evaluated by ^1HMRS and CT scans of their livers. The intrahepatic content of lipid （IHCL） and CT liver and spleen ratios were measured. Results The BMI, WHR, serum ALT, FBG, TG, and UA were all elevated significantly in the NAFLD group and were （28.4 ± 2.4） kg/m^2, 0.91 ± 0.04, （71.5 ± 24.8） U/L, （5.67 ± 0.61） mmol/L, （2.48 ± 1.46） mmol/L, （420.7 ± 57.5） μ mol/L, respectively, P 〈 0.01 or 0.05. Meanwhile, in the NAFLD group, the IHCL calculated by ^1HMRS were increased and CT value ratios were decreased significantly compared with those of the control group （27.49% ± 12.27% vs 1.34% ± 0.79%, P 〈 0.01）. However, there was no correlation between the clinical features and the IHCL and between the clinical features and CT value ratios, but a negative correlation existed in the CT value ratio and IHCL. Conclusions The intrahepatic content of lipids can be measured precisely by ^1HMRS, and ^1HMRS is better than CT in quantitative evaluations of NAFLD.