磁共振质子波谱成像对慢性乙型肝炎合并肝脂肪变性的诊断价值

The Value of Magnetic Resonance Spectroscopy in the Diagnosis of Liver Fatty in Patients with Chronic Hepatitis B

目的探讨磁共振质子波谱成像(1H-MRS)在慢性乙型病毒性肝炎(CHB)合并肝脂肪变性的诊断价值。方法采用回顾性分析方法收集65例患者,男性44例(67.69%),女性21例(32.30%),年龄(44.40±11.60)岁(22~70岁),病理分级≥F1有42例(64.62%)。65例患者分为2组,其中CHB组47例,非CHB组18例。收集2组患者的肝穿刺病理及1H-MRS检测结果,以病理诊断为金标准,比较1H-MRS对2组患者肝脂肪变性的诊断价值。结果1H-MRS检查肝脏脂肪定量值用脂水比(LWR)显示,2组患者LWR与肝穿刺病理的相关系数rs分别为0.86,0.91(P<0.001)。2组患者的LWR诊断肝脂肪变性的AUC、敏感性、特异性、Youden指数等均较高。根据ROC曲线可见,CHB不影响1H-MRS的诊断效能,病理分度F≥1、≥2、≥3及≥4时,LWR用于肝脂肪变性诊断的阈值分别为1.54%,2.98%,9.25%及15.56%。结论CHB不影响1H-MRS对肝脂肪变性诊断的准确性;1H-MRS用于肝脂肪变性的诊断,稳定性高,准确性好。

Objective To evaluate the value of 1 H-proton magnetic resonance spectroscopy ( 1 H-MRS ) in the diagnosis of hepatic steatosis in patients with chronic hepatitis B (CHB).MethodsPatients were divided into the CHB group and the non-CHB group in this retrospective study.They all received liver biopsy and 1 H-MRS examination.The hepatic steatosis was diagnosed by pathology. Results There were 65 patients involved in this study, with 47 in the CHB group and 18 in the non-CHB group.The mean age was (44.40±11.60) years, with 44 (67.69%) males and 21(32.30%) females.There were 42 (64.0%) cases with steatosis grade≥F1.Lipid-water ratio (LWR) was used to estimate the liver steatosis in 1 H-MRS examination.A significant correlation between 1 H-MRS and liver biopsy results was found in both groups;the correlation coefficient were 0.86 in CHB group and 0.91 in non-CHB group (both P<0.001).The Kruskal-Wallis H test showed that there were significant differences between mean values of LWR according to the pathological grades.Receiver Operating Characteristic curve showed high values of area under the curve (AUC), sensitivity, specificity and Youden index of LWR for diagnosis hepatic steatosis.According to ROC curve, CHB did not affect the diagnostic efficiency of 1 H-MRS and the diagnostic threshold of LWR in F≥1, F≥2, F≥3, and F≥4 was 1.54%, 2.98%, 9.25% and 15.56% respectively.ConclusionCHB does not affect the accuracy of 1 H-MRS in the diagnosis of hepatic steatosis. 1H-MRS is of high stability and accuracy in the diagnosis of hepatic steatosis.