^(18)F-FDG摄取量诊断非酒精性脂肪性肝病患者罹患冠状动脉粥样硬化性心脏病探讨

Diagnosis of coronary atherosclerotic heart disease in patients with nonalcoholic fatty liver disease by CCTA and ^(18)F-FDG intake

目的探讨应用^(18)F-FDG摄取量诊断非酒精性脂肪性肝病(NAFLD)患者罹患冠状动脉粥样硬化性心脏病(CHD)的可行性。方法2020年1月~2021年12月我院诊治的NAFLD患者120例,均接受冠状动脉CT血管成像(CCTA)和^(18)F-氟代脱氧葡萄糖(FDG)正电子发射计算机断层显像(PET/CT)检查,绘制感兴趣区域(ROI),测量心脏标准摄取值【记录各层最大值(SUVmyo)】和肝脏SUV(SUVliv),计算SUVmyo/SUVliv比值(SUVratio)。结果在120例NAFLD患者中,经CCTA检查发现CHD患者28例;CHD组体质指数、空腹血糖、总胆固醇和甘油三酯水平分别为(28.6±2.2)kg/m^(2)、(6.9±2.1)mmol/L、(6.3±0.9)mmol/L和(3.7±0.4)mmol/L,均显著高于NAFLD组【分别为(25.1±2.3)kg/m^(2)、(5.2±1.5)mmol/L、(4.4±0.5)mmol/L和(1.6±0.2)mmol/L,P<0.05】,合并代谢综合征、高血压和糖尿病占比分别为28.6%、32.1%和28.6%,均显著高于NAFLD组的2.1%、10.8%和4.3%(P<0.05);CCTA检查发现,CHD组非钙化性斑块和非钙化斑块明显狭窄占比分别为28.6%和25.0%,均显著高于NAFLD组的4.3%和2.2%(P<0.05);^(18)F-FDG PET/CT检查显示,CHD组SUVmyo和SUVratio分别为(3.8±1.1)和(1.6±0.3),均显著低于NAFLD组【分别为(6.8±1.6)和(3.1±0.9),P<0.05】。结论采用CCTA和PET/CT检查可以帮助筛查NAFLD患者CHD,其准确性还需与冠状动脉造影比较。

Objective The aim of this study was to investigate the diagnosis of coronary atherosclerotic heart disease(CHD)in patients with nonalcoholic fatty liver disease(NAFLD)by coronary artery CT angiography(CCTA)and ^(18)F-FDG positron emission computed tomography(PET/CT).Methods 120 patients with NAFLD were recruited in our hospital between January 2020 and December 2021,and all underwent CCTA and PET/CT scan.The myocardial and liver standard uptake values(SUV)were obtained and recorded as SUVmyo,SUVliv and SUVmyo/SUVliv ratio(SUVratio).Results Out of the 120 patients with NAFLD,the CCTA found CHD in 28 cases(23.3%);the body mass index,fasting blood glucose,total cholesterol and triglyceride levels in patients with NAFLD and CHD were(28.6±2.2)kg/m^(2),(6.9±2.1)mmol/L,(6.3±0.9)mmol/L and(3.7±0.4)mmol/L,all significantly higher than[(25.1±2.3)kg/m^(2),(5.2±1.5)mmol/L,(4.4±0.5)mmol/L and(1.6±0.2)mmol/L,P<0.05],and the concomitant proportions of metabolic syndrome,hypertension and diabetes were 28.6%,32.1%and 28.6%,all much higher than 2.1%,10.8%and 4.3%(P<0.05)in patients with NAFLD;the CCTA scan showed the non-calcified plaque and non-calcified plaque stenosis in coronary arteries in patients with CHD were 28.6%and 25.0%,both much higher than 4.3%and 2.2%(P<0.05)in patients with NAFLD;the ^(18)F-FDG PET/CT scan demonstrated that the SUVmyo and the SUVratio in patients with CHD were(3.8±1.1)and(1.6±0.3),both significantly lower than[(6.8±1.6)and(3.1±0.9),respectively,P<0.05]in patients with NAFLD alone.Conclusion The screening of CHD in patients with NAFLD by CCTA and PET/CT scan is convenient and safe,which might be verified by coronary angiography.