腹部超声对糖尿病合并非酒精性肝炎的筛查及相关因素

Diagnostic value of transabdominal ultrasonography in diabetes mellitus complicated with nonalcoholic steatohepatitis and risk factors for nonalcoholic steatohepatitis

目的:研究腹部超声在2型糖尿病(type 2diabetes mellitus,T2DM)患者非酒精性肝炎的筛查价值,并探讨非酒精性脂肪肝炎(nonalcoholic steatohepatitis,NASH)发生的相关因素.方法:选取2013-01/2015-12余姚市第二人民医院收治的100例T2DM患者作为研究对象,根据病理检查结果对患者进行分组:其中无肝脏病变94例,单纯性脂肪肝组62例,NASH组44例,比较各组患者临床资料、病理学检查结果、血生化检查结果及肝功能指标,比较单纯性脂肪肝组及NASH组的超声量化检查结果,分析NASH的相关因素.结果:各组患者的体质量指数(body mass index,BMI)、腰臀比(waist-to-hipratio,WHR)、空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(hemoglobin A1c,HbA1c)、血脂及肝功能检查结果差异具有统计学意义(P<0.05).超声量化检查结果:单纯性脂肪肝组轻度37例(59.68%),中度15例(24.19%),重度10例(16.13%);NASH组轻度4例(9.09%),中度22例(50.00%),重18度例(40.91%),差异具有统计学意义(P<0.05).超声量化检查结果与与炎症分级(G,r=0.763)及纤维化分级(S,r=0.375)具有显著相关性(P<0.05),与脂肪肝分度(F)无显著相关性(r=0.177,P>0.05).NASH与患者的病程、BMI、WHR、血脂及超声量化检查具有显著相关性(P<0.05).结论:腹部超声在糖尿病合并非酒精性肝炎的筛查中具有应用价值,结合相关因素可以提高诊断价值.

AIM：To assess the diagnostic value of transabdominal ultrasonography in type 2diabetes mellitus（T2DM） complicated with nonalcoholic steato hepatitis（NASH）,and to analyze the risk factors for NASH.METHODS：From January 2013 to December2015,200 patients with T2 DM were divided into three groups according to the results of ultrasonography and pathological examinations：94 patients in a non-hepatic lesion group,62 patients in a simple fatty liver group,and 44 patients in an NASH group.Clinical data,blood biochemical and liver function indexes were compared among the three groups.The results of quantitative ultraso nography were compared between the simple fatty liver group and NASH group.Risk factors for NASH were analyzed.RESULTS：BMI,WHR,FPG,HbA1 c,blood lipid and liver function indexes had significant differences among the three groups（P 0.05）.Quantitative ultrasonography showed that in the simple liver fatty liver group,37（59.68%）cases were mild,15（24.19%） were moderate and 10（16.13%） were serious;in the NASH group,the corresponding figures were 4（9.09%）,22（50.00%） and 18（40.91%）,respectively.There were significant differences between the two groups（P 0.05）.The result of quantitative ultrasonography had a significant correlation with G（r = 0.763,P 0.05） and S（r = 0.375,P 0.05）,but not with F（r = 0.177,P 0.05）.NASH was significantly related to duration of DM,BMI,WHR,blood lipid and results of quantitative ultrasonography（P 0.05）.CONCLUSION：Trans-abdominal ultrasonography has value in the screening of T2 DM complicated with NASH,and trans-abdominal ultrasonography in combination with evaluation of risk factors can increase the diagnostic accuracy.