摘要
目的:探讨3.0T氢质子磁共振波谱(^1H-magnetic resonance spectroscopy,^1H-MRS)定量测量2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD)患者肝脏脂肪含量的准确性。方法:选取2017年2月至2018年6月经临床及实验室血液生化检测确诊的30例T2DM合并NAFLD患者(T2DM-NAFLD组)和30例健康志愿者(正常对照组),所有受试者均需在禁食8 h后抽取空腹静脉血,检测血糖水平(Glu)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)等指标,对比2组检测结果的差异。血液生化检测后,所有受试者均进行^1H-MRS、双梯度回波磁共振成像(dual gradient echo-magnetic resonance imaging,DGE-MRI)以及CT检查,绘制ROC曲线,比较3种方法对肝脏脂肪变的诊断效能。采用PHILIPS自带软件对采集的原始^1H-MRS数据进行优化处理,采集所得的^1H-MRS谱线经过基线校正,得到感兴趣容积(volume of the interest,VOI)内水及脂类物质的波峰,并算出峰下面积及脂水比。应用Kappa检验比较3种方法对肝脏脂肪含量测定的准确性。采用SPSS 22.0软件进行数据分析。结果:T2DM-NAFLD组的Glu、ALT、AST、GGT、TG、TC和LDL较正常对照组均明显升高,而HDL则降低,差异均具有统计学意义(P<0.05)。T2DM-NAFLD组的脂水比显著高于正常对照组,差异具有统计学意义(P<0.01)。^1H-MRS诊断肝脏脂肪变的特异度、敏感度、阳性预测值及阴性预测值分别为100.00%、90.00%、100.00%、90.91%,均高于DGE-MRI及CT;^1H-MRS的Youden指数(0.924)和Kappa值(0.813)显著高于DGE-MRI和CT。结论:3.0T ^1H-MRS技术可以无创性评估T2DM合并NAFLD患者肝脏的脂肪含量,其效果显著优于DGE-MRI和CT。
Objective To investigate the accuracy of 3.0T ^1H-MRS in measuring liver fat content in patients with type 2 diabetes mellitus(T2DM)and nonalcoholic fatty liver disease(NAFLD).Methods Totally thirty patients with T2DM and NAFLD(T2DM-NAFLD group)confirmed by clinical and laboratory blood biochemical tests and thirty non-diabetic volunteers(control group)were selectedas the subjects from February 2017 to June 2018.All the subjects were required to take fasting venous blood 8 hours after fasting to detect Glu,ALT,AST,GGT,TG,TC,HDL and LDL,and the test results were compared in the two groups.All the patients underwent ^1H-MRS,DGE-MRI and CT scanning,and ROC curves were drawn to analyze the values of ^1H-MRS,DGE-MRI and CT scanning in the diagnosis of liver fat content in patients with T2DM and NAFLD.Philips software was used for raw ^1H-MRS data optimization,and the acquired ^1H-MRS spectral tine underwent baseline correction to determine the peaks of water and lipid at volume of interest(VOI)as well as the areas under peaks and lipid water ratios.The three methods had the accuracies for measuring liver fat content compared with Kappa test.SPSS 22.0 software was used for data analysis.Results Glu,ALT,AST,GGT,TG,TC and LDL of T2DM-NAFLD group gained significantly higher values than those of the control group,while HDL was lower obviously(P<0.05).The lipid water ratio of T2DM-NAFLD group was significantly higher than that of the control group.The specificity,sensitivity,positive and negative predictive values of ^1H-MRS were 100.00%,90.00%,100.00%and 90.91%respectively,which were higher than those of DGE-MRI and CT scanning;the Youden index(0.924)and Kappa value(0.813)of ^1H-MRS were significantly higher than those of DGE-MRI and CT scanning.Conclusion 3.0T ^1H-MRS can be used for non-invasive assessment of the fat content of liver in the T2DM-NAFLD patients,and behaves significantly better than DGE-MRI and CT scanning.
作者
马春忠
王维平
蔡春沉
张乐
刘晓智
王建军
郭文斌
MA Chun-zhong;WANG Wei-ping;CAI Chun-chen;ZHANG Le;LIU Xiao-zhi;WANG Jian-jun;GUO Wen-bin(Tianjin Fifth Central Hospital,Tianjin 300450,China)
出处
《医疗卫生装备》
CAS
2019年第12期45-49,57,共6页
Chinese Medical Equipment Journal
基金
天津市滨海新区卫生计生委科技项目（2015BW KY006)
