声脉冲辐射成像技术在早期非酒精性脂肪性肝炎诊断中的应用价值

Value of Acoustic Radiation Force Impulse Imaging in the Diagnosis of Early Non-alcoholic Steatohepatitis

目的评估声脉冲辐射成像技术(ARFI)在早期非酒精性脂肪性肝炎(NASH)诊断中的应用价值。方法采用随机数字表法将32只SD大鼠随机分为普通饲料组(n=8)和高脂饲料组(n=24),分别于4、8、12、16周末从高脂饲料组及普通饲料组随机抽取6只及2只行体质量、血生化、常规超声及ARFI检测,处死后取大鼠肝脏行HE染色,观察病理。结果 32只大鼠均未出现肝纤维化,根据病理结果分为M1组[轻中度单纯性脂肪肝(SS)]、M2组(重度SS)、M3组(重度SS合并早期NASH)和C组(正常对照)4组,早期NASH仅出现在重度脂肪肝组,其分布差异有统计学意义(P=0.006)。常规超声诊断脂肪肝程度与病理检查结果的符合率为34.4%(11/32)。M3组的ARFI值为(1.16±0.04)m/s,明显低于M2组的(1.22±0.05)m/s(t=2.301,P=0.04);M3组的LDL-C为(1.53±0.07)mmol/L,明显高于M2组的(1.21±0.22)mmol/L(t=3.075,P=0.01);两组大鼠在三酰甘油、总胆固醇、高密度脂蛋白、谷草转氨酶、谷丙转氨酶和体质量方面差异均无统计学意义(P均>0.05)。结论早期NASH的出现与脂肪肝程度相关。ARFI值可为重度SS患者是否合并早期NASH提供重要信息。

Objective To evaluate the value of acoustic radiation force impulse（ARFI） imaging in the diagnosis of early non-alcoholic steatohepatitis（NASH）. Methods Totally 32 SD rats were randomly divided into high-fat diet group（n = 24） and normal-diet group（n = 8） by using the random number table. At the end of the 4^（th）,8^（th）,12^（th）,and 16 thweek,six rats from the high-diet group and two rats from the normal-diet group were selected blindly for weighting,blood biochemical test,conventional ultrasound,and ARFI imaing.HE staining was used for pathological observation. Results None of the 32 rats developed liver fibrosis. Based on the pathological results,these rats were divided into M1 [mild-to-moderate simple fatty liver（SS） ],M2（severe SS）,M3（severe SS with early NASH）,and C groups（normal control）. Early NASH was seen only in the severe hepatic steatosis groups,and its distribution had a significant difference（P = 0. 006）. The diagnostic accuracy of conventional ultrasound based on histological results was 34. 4%（11/32）. The ARFI value of M3 group was significantly lower than that of M2 group [（1. 16 ± 0. 04） m/s vs.（1. 22 ± 0. 05） m/s; t =2. 301,P = 0. 04）,and the low-density lipoprotein of M3 group was significantly higher than M2 group [（1. 53 ±0. 07） mmol/L vs.（1. 21 ± 0. 22） mmol/L; t = 3. 075,P = 0. 01）,while other clinical indicators had no statistical difference between these two groups. Conclusions The development of early NASH is associated with the severity of hepatic steatosis. ARFI value can provide important information to identify early NASH in patients with severe hepatic steatosis.