磁共振IDEAL-IQ序列对非酒精性脂肪性肝病患者肝脏脂肪及铁沉积的诊断价值

目的探讨磁共振IDEAL-IQ序列在非酒精性脂肪性肝病(NAFLD)定量评估中的价值。方法回顾性分析50例临床诊断为NAFLD患者的临床资料,收集年龄、性别、血糖、血脂、尿酸、肝功能等临床及实验室指标。所有患者均接受肝脏磁共振IDEAL-IQ序列扫描并通过测量获得肝脏脂肪分数(PDFF)及铁沉积(R2^(*))值,其中22例患者行肝脏活检并获得肝脏脂肪变性的病理学分级(S0~3级)。采用相关性分析评价PDFF及R2^(*)值与临床、实验室指标的相关性。采用ROC曲线分析PDFF值对不同程度脂肪肝的诊断效能,采用约登指数确定最佳截断值。结果PDFF值与UA、AST、ALT、HDL-C相关(r=0.425,P<0.01;r=0.584,P<0.01;r=0.505,P<0.01;r=-0.296,P<0.05);R2^(*)值与各临床及实验室指标无明显相关性(P>0.05);PDFF评估轻度(S1)、中度(S2)及重度(S3)脂肪肝的AUC值0.972(95%CI:0.905~1.000)、0.902(95%CI:0.765~1.000)、0.825(95%CI:0.528~1.000),P<0.05。结论PDFF值与多项生化指标相关,可作为补充指标定量评价NAFLD;与金标准比较,PDFF值对不同程度脂肪肝展现出良好的诊断效能。

Objective To investigate the application value of MRI IDEAL-IQ sequence in quantitative assessment of non-alcoholic fatty liver disease(NAFLD),and to provide more information for non-invasive diagnosis of NAFLD patients.Methods 50 patients diagnosed with NAFLD were retrospectively included.Age,gender,blood glucose,blood lipid,uric acid,liver function and other clinical and laboratory indicators were collected.All patients underwent liver magnetic resonance IDEAL-IQ scans and liver fat fraction(PDFF)and iron deposition(R2^(*))values were measured.Liver biopsies were performed in 22 patients and pathological grades of liver steatosis(S0-3)were obtained.Correlation analysis was used to evaluate the correlation between PDFF and R2^(*)values and clinical and laboratory indicators.ROC curve was used to analyze the diagnostic efficiency of PDFF value in different degrees of fatty liver,and Jorden index was used to determine the best cut-off value.Results PDFF was correlated with UA,AST,ALT and HDL-C(r=0.425,P<0.01;r=0.584,P<0.01;r=0.505,P<0.01;r=-0.296,P<0.05).There was no significant correlation between R2^(*)and clinical and laboratory indexes(P>0.05).The AUC values of mild(S1)or above,moderate(S2)or above and severe(S3)fatty liver were 0.972(95%CI:0.905~1.000),0.902(95%CI:0.765~1.000)and 0.825(95%CI:0.765~1.000)in PDFF assessment.(0.528~1.000),P<0.05.Conclusion The PDFF value was correlated with a number of biochemical indicators,and could be used as supplementary indicators for quantitative evaluation of NAFLD.Compared with the gold standard,PDFF value showed a good diagnostic efficacy for different degrees of fatty liver.