不同肝组织学特征非肥胖型NAFLD患者磁共振质子密度脂肪分数表现

MRI proton density and fat fraction in non-obese NAFLD patients with different liver histological characteristics

目的比较非肥胖型非酒精性脂肪性肝病(NAFLD)、慢性乙型肝炎(CHB)患者临床资料,分析不同肝脂肪变程度、肝组织炎症程度及肝纤维化分期等肝组织学特征非肥胖型NAFLD患者磁共振质子密度脂肪分数(MRI-PDFF)表现。方法收集2019年1月至2021年7月期间非肥胖型NAFLD患者74例(男40例,女34例),年龄(42.3±11.4)岁;CHB患者92例(男64例,女性28例),年龄(38.1±10.3)岁。非肥胖型NAFLD、CHB诊断符合标准,比较患者临床资料,分析不同肝组织学特征非肥胖型NAFLD患者MRI-PDFF表现。结果非肥胖型NAFLD、CHB患者高血压为29例(39.2%)、11例(12.0%),差异具有统计学意义(χ^(2)=16.629,P<0.05);非肥胖型NAFLD患者TG、TC、LDL及HDL为(2.4±1.0)mmol/L、(5.3±1.4)mmol/L、(3.5±0.9)mmol/L及(1.0±0.4)mmol/L,与CHB患者[分别为(1.2±0.6)mmol/L、(4.0±1.0)mmol/L、(2.3±0.6)mmol/L及(1.5±0.6)mmol/L]比,差异具有统计学意义(t=10.502,4.104,4.230,-5.018,P<0.05);非肥胖型NAFLD、CHB患者MRI-PDFF为(16.5±5.2)%、(3.8±1.1)%,差异具有统计学意义(t=22.428,P<0.05)。NAFLD患者肝脂肪变程度S0级10例,S1级25例,S2级28例及S3级11例,各肝脂肪变程度MRI-PDFF分别为(3.3±1.5)%、(9.2±3.3)%、(16.2±5.0)%及(21.4±6.4)%,差异具有统计学意义(t=12.234,P<0.05),而各肝组织炎症程度、肝纤维化分期患者MRI-PDFF差异不具有统计学意义(P>0.05)。结论随着非肥胖型NAFLD患者肝脂肪变程度增加,MRI-PDFF显著上升,有助于定量评价非肥胖型NAFLD患者肝脏脂肪含量。

Objective To compare the clinical data of non-obese nonalcoholic fatty liver disease(NAFLD)patients with those of chronic hepatitis B(CHB)patients,and analyze the performance of magnetic resonance imaging-estimated proton density fat fraction(MRI-PDFF)of non-obese NAFLD patients with different liver histological features such as the degrees of steatosis and inflammation,and the stages of liver fibrosis.Methods A total of 74 non-obese NAFLD patients(40 males and 34 females)aged(42.3±11.4)years from January 2019 to July 2021 were collected.There were 92 patients with CHB(64 males and 28 females)with an average age of(38.1±10.3)years.The diagnosis of non-obese NAFLD and CHB meet the standard criteria.The clinical data of non-obese NAFLD patients were compared with CHB patients.The associations between MRI-PDFF manifestations with different liver histological features were analyzed.Results There were 29 cases(39.2%)and 11 cases(12.0%)of hypertension in non-obese NAFLD and CHB patients,respectively,with statistical significance(χ^(2)=16.629,P<0.05).The levels of total triglyceride(TG),total cholesterol(TC),low-density lipoprotein(LDL)and high-density lipoprotein(HDL)in non-obese NAFLD patients were(2.4±1.0)mmol/L,(5.3±1.4)mmol/L,(3.5±0.9)mmol/L and(1.0±0.4)mmol/L,respectively,which were significantly higher than those of[(1.2±0.6)mmol/L,(4.0±1.0)mmol/L,(2.3±0.6)mmol/L and(1.5±0.6)mmol/L in CHB patients(t=10.502,4.104,4.230,-5.018,P<0.05).The MRI-PDFF of non-obese NAFLD and CHB patients were(16.5±5.2)%and(3.8±1.1)%,respectively,with statistical significance(t=22.428,P<0.05).For the degrees of hepatic steatosis of the non-obese NAFLD patients,10 cases were in S0,25 cases were in S1,28 cases were in S2 and 11 cases were in S3.The MRI-PDFF of each degree of hepatic steatosis was(3.3±1.5)%,(9.2±3.3)%,(16.2±5.0)%and(21.4±6.4)%,respectively,with statistical significance(t=12.234,P<0.05).However,there was no significant difference in MRI-PDFF among patients with different liver inflammatory degrees and liver fibrosis stages(P>0.05).Conclusion With the increased severity of liver steatosis in non-obese NAFLD patients,The MRI-PDFF significantly increase which is helpful to quantitatively evaluate liver fat content and improve the diagnosis.