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磁共振质子密度脂肪分数(MRI-PDFF)评估慢性HBV感染者肝脂肪变性及分布特点

王丽旻 包超 赵凯越 靳婕华 郑卓肇 黄缘

引用本文:
Citation:

磁共振质子密度脂肪分数(MRI-PDFF)评估慢性HBV感染者肝脂肪变性及分布特点

DOI: 10.12449/JCH240511
基金项目: 

北京市自然科学基金 (7202240);

清华大学自主科研项目 (2022PY002)

伦理学声明: 本研究方案于2021年5月26日经由北京清华长庚医院伦理委员会审批,批号:21228-0-01,所纳入患者均签署知情同意书。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:王丽旻负责课题设计,资料分析,撰写论文;包超、赵凯越、靳婕华参与收集数据;黄缘、郑卓肇负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    黄缘, huangy9815@163. com (ORCID: 0000-0003-1392-4619)

Value of magnetic resonance imaging-proton density fat fraction in evaluating the degree and distribution characteristics of hepatic steatosis in patients with chronic hepatitis B virus infection

Research funding: 

Beijing Natural Science Foundation (7202240);

Tsinghua University Independent Research (2022PY002)

More Information
    Corresponding author: HUANG Yuan, huangy9815@163.com (ORCID: 0000-0003-1392-4619)
  • 摘要:   目的  利用磁共振质子密度脂肪分数(MRI-PDFF)评估慢性HBV感染者的肝脂肪变性的程度。  方法  选择北京清华长庚医院2018年1月—2022年12月门诊或者住院,明确诊断为慢性HBV感染,年龄>16岁的患者。所有患者均在本院行肝脏磁共振检查。依据是否合并肝硬化进行分组,比较患者的各个肝段PDFF值的一致性。使用Kappa一致性检验、组内相关系数(ICC)进行一致性分析。  结果  纳入76例核苷(酸)类似物经治患者,其中30.26%(23例)合并肝硬化,所有患者的MRI-PDFF算术均值波动在1.49%~30.93%,依据MRI-PDFF≥5%诊断为脂肪肝,38.16%(29例)患者合并脂肪肝。76例患者的全肝PDFF算术均值低于全肝PDFF加权均值,全肝PDFF加权均值、全肝PDFF算术均值、左半肝及右半肝的PDFF算术均值比较,差异无统计学意义(F=0.39,P=0.76)。各个肝段、左/右半肝PDFF算术均值与全肝PDFF加权均值、全肝PDFF算术均值的一致性较强(ICC均>0.75),但右半肝PDFF算术均值与全肝PDFF加权均值的一致性高于左半肝。合并肝硬化组患者在区分脂肪肝诊断的一致性检验方面,Ⅶ段PDFF算术均值与全肝PDFF加权均值一致性差(Kappa=0.39),左半肝、Ⅰ、Ⅱ、Ⅲ、Ⅴ、Ⅵ、Ⅷ为中等一致。合并肝硬化的患者Ⅶ段PDFF算术均值与全肝PDFF加权均值一致性最低,Ⅳ段一致性最高。未合并肝硬化的患者Ⅱ段PDFF算术均值与全肝PDFF加权均值一致性最低,Ⅴ段的一致性最高。  结论  MRI-PDFF评估慢性HBV感染者的肝脂肪变性更全面,合并肝硬化的患者各肝段PDFF算术均值与全肝PDFF加权均值的一致性差异大。

     

  • 表  1  患者的临床特征

    Table  1.   Clinical characteristics of patients

    项目 数值
    性别[例(%)]
    53(69.74)
    23(30.26)
    年龄(岁) 42(36~54)
    BMI(kg/m2 24.95±3.89
    合并肝硬化[例(%)] 23(30.26)
    受控衰减参数(dB/m) 262.36±36.72
    MRI-PDFF(%) 6.89±5.32
    LSM(kPa) 8.96±4.14
    HBeAg阳性[例(%)] 28(36.84)
    HBV DNA阳性[例(%)] 16(21.05)
    ALT(U/L) 40.34±28.10
    AST(U/L) 30.00±11.20
    TBil(mmol/L) 15.11±11.50
    Alb(g/L) 47.77±26.40
    PLT(×109/L) 211.86±77.61
    TC(mmol/L) 4.63±2.11
    TG(mmol/L) 1.71±0.82
    LDL-C(mmol/L) 2.77±0.91
    下载: 导出CSV

    表  2  76例患者肝脏各部位的PDFF值

    Table  2.   PDFF of liver segments in 76 patients

    项目 均值(%) 标准差(%) 最小值(%) 最大值(%) P25(%) P50(%) P75(%)
    全肝加权 6.91 5.97 1.14 30.89 2.36 3.35 7.96
    全肝 6.89 5.32 1.49 30.93 2.35 3.36 8.08
    左半肝 6.29 5.53 0.81 30.71 1.93 3.11 8.27
    右半肝 7.27 5.93 1.31 30.98 2.36 3.50 8.36
    Ⅰ段 6.45 4.53 0.88 24.31 2.00 4.00 8.55
    Ⅱ段 7.03 6.37 0.32 32.80 2.41 4.44 8.58
    Ⅲ段 6.19 5.68 0.20 34.10 1.52 2.63 9.30
    Ⅳ段 6.86 5.41 0.67 32.74 2.73 3.35 8.01
    Ⅴ段 7.14 6.06 0.72 33.22 2.33 3.16 8.71
    Ⅵ段 7.16 6.47 0.93 28.80 2.83 3.17 8.22
    Ⅶ段 7.17 6.43 1.01 31.12 2.17 3.74 10.14
    Ⅷ段 7.49 6.63 0.83 33.54 2.46 4.16 11.51
    注:P25,第25百分位数,P50,中位数,P75,第75百分位数。
    下载: 导出CSV

    表  3  各肝段、左/右半肝PDFF算术均值与全肝PDFF加权均值、全肝PDFF算术均值的一致性

    Table  3.   Consistency of arithmetic mean PDFF of each hepatic segment and left/right lobes of the liver with weighted mean PDFF of the whole liver and arithmetic mean PDFF of the whole liver

    项目 全肝加权均值 全肝算术均值
    ICC值 P ICC值 P
    全肝加权均值 - 0.96 <0.01
    全肝算术均值 0.96 <0.01 -
    左半肝算术均值 0.97 <0.01 0.92 <0.01
    右半肝算术均值 0.99 <0.01 0.98 <0.01
    Ⅰ段算术均值 0.96 <0.01 0.92 <0.01
    Ⅱ段算术均值 0.92 <0.01 0.97 <0.01
    Ⅲ段算术均值 0.95 <0.01 0.91 <0.01
    Ⅳ段算术均值 0.98 <0.01 0.98 <0.01
    Ⅴ段算术均值 0.99 <0.01 0.99 <0.01
    Ⅵ段算术均值 0.96 <0.01 0.97 <0.01
    Ⅶ段算术均值 0.98 <0.01 0.98 <0.01
    Ⅷ段算术均值 0.97 <0.01 0.96 <0.01
    下载: 导出CSV

    表  4  各肝段及全肝PDFF算术均值和全肝PDFF加权均值对肝脂肪变性诊断的一致性比较

    Table  4.   Comparison of the consistency of arithmetic mean PDFF of each hepatic segment and the whole liver and weighted mean PDFF of the whole liver in diagnosis of hepatic steatosis

    项目 区分PDFF≥5%和<5%的Kappa值 P
    全肝 0.97 <0.01
    左半肝 0.86 <0.01
    右半肝 0.94 <0.01
    Ⅰ段 0.89 <0.01
    Ⅱ段 0.86 <0.01
    Ⅲ段 0.88 <0.01
    Ⅳ段 0.91 <0.01
    Ⅴ段 0.91 <0.01
    Ⅵ段 0.86 <0.01
    Ⅶ段 0.88 <0.01
    Ⅷ段 0.86 <0.01
    下载: 导出CSV

    表  5  合并肝硬化与未合并肝硬化全肝加权PDFF均值与各个肝段PDFF算术均值的一致性比较

    Table  5.   Comparison of the consistency of weighted mean PDFF of the whole liver and arithmetic mean PDFF of each hepatic segment in patients with and without liver cirrhosis

    项目 合并肝硬化(n=23) 未合并肝硬化(n=53)
    ICC值 P Kappa值 P ICC值 P Kappa值 P
    左半肝 0.81 <0.01 0.56 <0.01 0.96 <0.01 0.87 <0.01
    右半肝 0.88 <0.01 0.83 <0.01 0.99 <0.01 0.92 <0.01
    Ⅰ段 0.78 <0.01 0.57 <0.01 0.97 <0.01 0.83 <0.01
    Ⅱ段 0.76 <0.01 0.48 0.02 0.95 <0.01 0.75 <0.01
    Ⅲ段 0.82 <0.01 0.65 <0.01 0.95 <0.01 0.79 <0.01
    Ⅳ段 0.87 <0.01 0.83 <0.01 0.99 <0.01 0.87 <0.01
    Ⅴ段 0.82 <0.01 0.65 <0.01 0.99 <0.01 0.92 <0.01
    Ⅵ段 0.74 <0.01 0.48 <0.01 0.99 <0.01 0.83 <0.01
    Ⅶ段 0.68 <0.01 0.39 0.03 0.99 <0.01 0.84 <0.01
    Ⅷ段 0.76 <0.01 0.57 <0.01 0.98 <0.01 0.82 <0.01
    注:ICC值,全肝PDFF加权均值与左半肝、右半肝、各个肝段PDFF算术均值的相关系数;Kappa值,区分PDFF≥5%和<5%的Kappa值。
    下载: 导出CSV
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  • 收稿日期:  2023-07-27
  • 录用日期:  2023-09-05
  • 出版日期:  2024-05-25
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