mDixon Quant定量评估不同病程2型糖尿病患者胰腺脂肪和铁含量的初步研究

A preliminary study of mDixon Quant quantitatively assessment of pancreatic fat and iron content in patients of type 2 diabetes mellitus with different stages

目的:应用mDixon Quant定量评估不同病程2型糖尿病(T2DM)患者胰腺各部位的脂肪含量和铁含量。方法:前瞻性收集2019年9月-2023年12月确诊的糖尿病前期组(n=30)和T2DM组(n=63)患者,T2DM组又根据患病时间分为≤5年组(DMa组,n=31)和>5年组(DMb组,n=32);同时纳入40名健康志愿者作为对照组。所有受试者均行腹部mDixon Quant序列扫描,获得胰头、胰体、胰尾的脂肪分数(FF)值和R2^(*)值。采用单因素方差分析、Kruskal-Wallis检验比较组间胰腺各部位FF值及R2^(*)值的差异,采用Pearson或Spearman、偏相关分析比较各参数值与生化指标的相关性,以及各参数之间的相关性。采用受试者工作特征曲线(ROC)分析各相关参数鉴别各组的诊断效能。结果:对照组、前期组、DMa组内胰腺各部位FF值和R2^(*)值无显著差异;DMb组胰头和胰尾、胰体和胰尾FF值和R2^(*)值均具有显著差异(P均<0.05),且胰尾部FF值和R2^(*)值均最高。对照组、前期组、DMa组与DMb组之间胰腺各部位FF值和R2^(*)值差异均具有统计学意义(P<0.05),两两比较显示,除DMa组与DMb组外,任意两组间胰腺各部位FF值和R2^(*)值均存在显著差异(P<0.05)。校正BMI后,胰头、胰体、胰尾FF值和R2^(*)值与FPG、2h OGTT、HbA1c均呈正相关(r均>0.300,P均<0.001);胰腺FF值和R2^(*)值呈显著正相关(r=0.675,P<0.001)。ROC分析结果表明在区分对照组与前期组、前期组和T2DM组时,胰腺各部位FF值和R2^(*)值的诊断效能均较高且没有显著差异。结论:mDixon Quant可无创、定量评估不同病程T2DM患者胰腺脂肪含量和铁含量。糖尿病前期及T2DM患者均存在胰腺脂肪含量和铁含量的增加,随着病程进展二者分布不均,胰尾部为著。

Objective:mDixon Quant was used to quantitatively evaluate the fat content and iron content in different parts of pancreas in patients of type 2 diabetes mellitus(T2DM)with different stages.Methods:Patients in the pre-diabetes group(n=30)and T2DM group(n=63)diagnosed from September 2019 to December 2023 were prospectively collected,and the T2DM group was further divided into the≤5 years group(DMa group,n=31)and the>5 years group(DMb group,n=32)according to the duration of the disease;40 healthy volunteers were also included as the control group.All participants underwent abdominal mDixon Quant sequence scanning to obtain fat fraction(FF)and R2^(*)values of pancreatic head,body and tail.One-way analysis of variance(ANOVA)and Kruskal-Wallis were used to compare the differences of FF and R2^(*)values in different parts of pancreas between groups,Pearson or Spearman and partial correlation analysis was used to compare the correlation between each parameter and biochemical indicators,as well as the correlation between each parameter.The diagnostic efficacy of each relevant parameter to identify each group was analyzed using receiver operating characteristic(ROC)curve.Results:There were no significant differences in FF and R2^(*)values in each part of pancreas in control group,prediabetes group and DMa group.There were significant differences in the FF and R2^(*)values between the head and tail of pancreas,body and tail of pancreas in DMb group(P<0.05),and FF and R2^(*)values in tail of pancreas was the highest.There were statistically significant differences in FF and R2^(*)values at all parts of pancreas between control group,prediabetes group,DMa group and DMb group(P<0.05).Pairwise comparison showed that there were significant differences in FF and R2^(*)values at all parts of pancreas between any two groups except between the DMa and DMb group(P<0.05).After correcting for BMI,FF and R2^(*)values of pancreatic head,body and tail were positively correlated with FPG,2h OGTT and HbA1c(r>0.300,P<0.001).There was a significant positive correlation between FF and R2^(*)values(r=0.675,P<0.001).ROC analysis results showed that the diagnostic efficacy of FF and R2^(*)values in various parts of the pancreas was higher and had no significant difference when differentiating the control group from the earlier group,and the earlier group from the T2DM group.Conclusion:mDixon Quant can be used to quantitatively and noninvasively evaluate pancreatic fat and iron content in patients with different stages of T2DM.Pancreatic fat overload and iron overload were present in both pediabetes and T2DM patients,and were unevenly distributed,especially in the pancreatic tail.