NAFLD 血清肝纤维化指标与1H-MRS 测定肝内脂肪含量的相关性研究

Study on correlation between liver fibrosis indexes and liver fat content quantitatively detected by 1 H-MRS in nonalcoholic fatty liver disease patients

目的探讨非酒精性脂肪肝病患者(nonalcoholic fatty liver disease patients,NAFLD)血清肝纤维化指标与选定区域MR氢质子波谱(1 H-MR spectroscopy,1 H-MRS)定量检测肝内脂肪含量的相关性。方法对100例NAFLD(单纯性非酒精性脂肪肝患者55例,非酒精性脂肪性肝炎患者45例)及50例健康志愿者行常规MR扫描及1 H-MRS检查,所有入选者采用放射免疫分析法(radioimmunoassay,RIA)测定血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型胶原(PCⅢ)、Ⅳ型胶原(CⅣ)四个肝纤维化指标。MR扫描包括T1WI、T2WI及1 H-MRS。感兴趣区选择右前叶及左内叶少血管及胆管区域,扫描不应用水饱和技术,对所得数据进行相关性分析。结果正常对照组MRS可见明显高耸的水峰及低平或无脂质峰,脂肪肝组可见明显水峰及脂质峰。脂肪肝组脂质峰下面积普遍较正常组高,有统计学意义;脂肪肝组水峰下面积较正常组低,无统计学意义。肝炎组随着肝纤维化指标的升高,肝内脂肪含量减低(P<0.05);脂肪肝组与肝炎组及健康对照组比较血清HA、LN、PCⅢ、CⅣ的值明显增大(P<0.05);脂肪肝组患者肝纤维化指标较健康对照组无明显增高(P>0.05)。结论 1 H-MRS技术定量检测脂肪肝是可行、无创定量评估肝内脂肪含量的方法。非酒精性脂肪性肝炎有肝纤维化趋势,肝内脂肪含量与肝纤维化的进展密切相关。

Objective To investigate the relationship between the liver fibrosis indexes and liver fat content quantitatively detected by 1 H‐MRS in nonalcoholic fatty liver disease patients （NAFLD） .Methods 100 cases of NAFLD （55 patierts with sinple NAFLD and 45 patients with nonalcoholic steatohepatitis） and 50 healthy volunteers underwent conventional MR imaging and 1 H‐MRS analysis .Meanwhile ,the values of the four liver fibrosis indexes ,including HA ,LN ,PC Ⅲand C Ⅳ were detected by radioimmunoassay .MR imaging included T1 WI ,T2 W imaging and 1 H‐MRS scan .The regions of interest was chosen the areas with fewer blood vessels and bile duct ,placing in the right anterior lobe and left medial lobe .The scan should not use water saturated technology .1 H‐MRS sequence measured the areas under the peaks of H2 O and lipid .The relative contents of lipid compound were calculated .Then the data were correlatively analyzed .Results On 1 H‐MRS protruding high H2 O peak and a flat low or no lipid peak were observed in the normal group ,while the protru‐ding high H2 O peak and a high lipid peak appeared in the fatty liver group .The areas under the lipid peak in the fatty liver group were generally higher than the normal group （ P ＆lt; 0 .05） .The areas under the H2 O peak in the fatty liver group were generally reduced （ P ＆gt; 0 .05） .The liver fibrosis indexes were negatively correlated with intrahepatic fat content in NASH patients （ P ＆lt; 0 .05） ,the same to with the liver fibrosis indexes .The liver fibrosis indexes in the simple nonalco‐holic fatty liver group were no obviously increased （ P ＆gt; 0 .05） .Conclusion 1 H‐MRS imaging is feasible to quantitatively detect liver fat and is a fast ,safe and non‐invasive method .Liver fibrosis trend is found in NASH .The intrahepatic fat content is closely related to the progress of liver fibrosis .