在2013年欧洲肝病学会（European Association for the Study of the Liver,EASL）主办的国际肝病大会（the International Liver Congress,ILC）上，中国香港公布的一项研究证实，一项非侵入性检测——磷磁共振波谱（31P-MRS）检测在诊断非酒精性脂肪性肝炎（NASH）中准确高且无创。
肝活检目前是诊断非酒精性脂肪性肝病（NAFLD）的金标准，但在临床上通常受限制。磷磁共振波谱（31P-MRS）可以在体内进行无创性的肝细胞代谢评估，具有区分NAFLD类型的生化潜能。
研究人员在151名受试者中开展31P-MRS，包括健康对照组（n＝19）和NAFLD患者：单纯性脂肪肝（n= 37）和NASH（N = 95）。
与对照组相比，NAFLD患者有较高的体重，腰围，身体质量指数（BMI），糖尿病和高血压增高趋势，高丙氨酸氨基转移酶（ALT）和甘油三酯的水平，而NASH的患者比单纯性脂肪肝患者有更高的BMI（P=0.007），更高的血清ALT（P=0.034）和糖化血红蛋白（P=0.030）水平。31P-MRS检测中发现 ，NAFLD患者[PME+PDE]/TP和PDE/TP升高（P＜0.001）。NASH患者表现为总ATP/TP和A-ATP/TP降低（P＜0.004）但PME/[PME+PDE]和GPC/[PME+PDE]正常，而单纯性脂肪肝ATP/TP和A-ATP/TP正常，PME[PME+PDE]降低（P=0.026），GPC/[PME+PDE]升高（P=0.009）。总ATP/TP的受试者工作特征曲线下面积（AUROC）为0.68（95%CI，0.58–0.75），诊断NASH有91%的敏感性和特异性。
作者总结道，31P-MRS显示ATP和PDE水平发生明显改变，与线粒体功能障碍和内质网应激一致，而这两者被认为是NALFD进展的关键因素。31P-MRS与肝活检在NAFLD诊断方面的准确性相当。
论文摘要：
Phosphorus magnetic resonance spectroscopy in non-alcoholic fatty liver disease
Conclusion: 31P-MRS shows distinct alterations in ATP and PDE levels which are concordant with mitochondrial dysfunction and endoplasmic reticulum stress, considered to be key players in the progression of NALFD. 31P-MRS shows fair diagnostic accuracy for NASH.
论文摘要：
Phosphorus magnetic resonance spectroscopy in non-alcoholic fatty liver disease
Background and Aims: Liver biopsy is the gold standard for diagnosing non-alcoholic fatty liver disease (NAFLD) but with practical constraints. Phosphorus magnetic resonance spectroscopy (31P-MRS) allows in vivo assessment of hepatocellular metabolism and has shown potential for biochemical differentiation in diffuse liver disease. Our aim was to describe spectroscopic signatures in biopsy-proven NAFLD and to determine diagnostic performance of 31P-MRS for non-alcoholic steatohepatitis (NASH).
Methods: 31P-MRS was performed in 151 subjects, comprised of healthy controls (n = 19) and NAFLD patients with non-NASH (n = 37) and NASH (n = 95). Signal intensity ratios for phosphomonoesters (PME), phosphodiesters (PDE) including glycerophosphocholine (GPC), total adenosine triphosphate (ATP) including a-ATP, and inorganic phosphate (Pi), expressed relative to [PME+PDE] or total phosphate (TP), were obtained.
Results: Compared with controls, NAFLD patients had significantly higher body weight, waist circumference, body mass index (BMI), higher tendency for diabetes and hypertension, and elevated alanine aminotransferase (ALT) and triglyceride levels, while NASH patients had higher BMI (p = 0.007), higher serum ALT (p = 0.034) and glycosylated hemoglobin (p = 0.030) levels than non-NASH patients. With respect to 31P-MRS, NAFLD patients had increased [PME+PDE]/TP and PDE/TP (p < 0.001). NASH patients showed decreased total ATP/TP and a-ATP/TP (p < 0.004) but normal PME/[PME+PDE] and GPC/[PME+PDE], whereas non-NASH showed normal ATP/TP and a-ATP/TP, decreased PME/[PME+PDE] (p = 0.026) and increased GPC/[PME+PDE] (p = 0.009). Area under the receiveroperating characteristics curve (AUROC) for total ATP/TP was 0.68(95% confidence interval CI, 0.58–0.75), and cutoff values of 0.4046 and 0.3173 yielded 91% sensitivity and specificity for diagnosing NASH. AUROC for a-ATP/TP was 0.71 (95% CI, 0.62–0.79), with 91% sensitivity and specificity using thresholds of 0.1636 and 0.1057, respectively.
Conclusion: 31P-MRS shows distinct alterations in ATP and PDE levels which are concordant with mitochondrial dysfunction and endoplasmic reticulum stress, considered to be key players in the progression of NALFD. 31P-MRS shows fair diagnostic accuracy for NASH.
