韩洁;吕珂;李玉秀;王亮;戴晴;姜玉新;李曾一;周美岑;
HAN Jie;L Ke;LI Yu-xiu;WANG Liang;DAI Qing;JIANG Yu-xin;LI Zeng-yi;ZHOU Mei-cen;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院超声医学科
• 2:中国医学科学院北京协和医学院北京协和医院内分泌科

摘要(Abstract)：

目的探讨应用计算机辅助测定肝脏超声图像肝肾回声比值及肝脏回声衰减系数对2型糖尿病(type 2 diabetes mellitus,T2DM)患者脂肪肝定量评估的临床价值及血生化指标与非酒精性脂肪肝(non-alcoholic fatty liver,NAFL)的相关性。方法选择2011年11月至2013年5月在北京协和医院内分泌门诊就诊的T2DM患者64例,所有患者均接受同日血生化检测及肝脏灰阶超声检查,根据超声检查结果将患者分为正常组、轻度脂肪肝组、中-重度脂肪肝组,应用计算机辅助超声图像分析软件测定肝肾回声比值和肝脏回声衰减系数。结果肝脏回声衰减系数及甘油三酯(triglyceride,TG)在正常组[0.954±0.103及(1.10±0.71)mmol/L]、轻度脂肪肝组[1.206±0.198及(1.82±0.84)mmol/L]、中-重度脂肪肝组[1.546±0.400及(2.86±1.75)mmol/L]间差异均具有统计学意义(P<0.05);肝肾回声比值在轻度脂肪肝组(1.350±0.302)、中-重度脂肪肝组(1.628±0.829)与正常组(0.926±0.175)间差异也具有统计学意义(P<0.05);肝肾回声比值、肝脏回声衰减系数及TG与糖尿病患者NAFL分度呈正相关(r=0.678,P<0.001;r=0.788,P<0.001及r=0.609,P<0.001)。结论超声肝肾回声比值及肝脏回声衰减系数可作为脂肪肝诊断的客观定量指标,可为临床T2DM患者NAFL随诊和评估治疗效果提供简易有效的辅助诊断工具。
Objective To assess the value of the sonographic quantification of non-alcoholic fatty liver( NAFL) in type 2 diabetes mellitus( T2DM) patients and explore the association of serum biochemical indicators with NAFL.Methods Totally 64 patients with T2DM were recruited from Peking Union Medical College Hospital from November 2011 to May 2013.All subjects underwent both serum biochemical test and ultrasonography at the same day.According to the ultrasound findings,all participants were divided into normal,mild,and moderate-severe fatty liver groups.Hepatorenal ratio and hepatic attenuation index were obtained from ordinary ultrasound images using computer software.Results There were statistical differences in hepatic attenuation index and triglyceride( TG) among the three groups [0.954 ± 0.103,1.206 ± 0.198,and 1.546 ± 0.400; and( 1.10 ± 0.71),( 1.82 ± 0.84),and( 2.86 ± 1.75) mmol / L; respectively]( all P < 0.05).For hepatorenal ratio,there were differences between normal,mild,and moderat-severe fatty liver group( 0.926 ± 0.175,1.350 ± 0.302,and 1.628 ± 0.829,respectively; P < 0.05).Hepatorenal ratio,hepatic attenuation index,and TG were positively correlated with the grading of NAFL( r = 0.678,P < 0.001; r = 0.788,P < 0.001; and r = 0.609,P < 0.001,respectively).Conclusions Hepatorenal ratio and hepatic attenuation index can be used as objective quantitative indexes in the diagnosis of NAFL in T2DM patients.They can be used as an easy and effective tool for follow-up and evaluation of NAFL treatment efficacy in these patients.

关键词(KeyWords)： 2型糖尿病;非酒精性脂肪肝;肝肾回声比值;肝脏回声衰减系数;血生化指标
type 2 diabetes mellitus;non-alcoholic fatty liver;hepatorenal ratio;hepatic attenuation index;serum biochemi-cal index

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81270878)

作者(Authors): 韩洁;吕珂;李玉秀;王亮;戴晴;姜玉新;李曾一;周美岑;
HAN Jie;L Ke;LI Yu-xiu;WANG Liang;DAI Qing;JIANG Yu-xin;LI Zeng-yi;ZHOU Mei-cen;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

参考文献(References)：

• [1]中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].中华肝脏病杂志,2006,14:161-163.
• [2]Fan JG,Zhu J,Li XJ,et al.Prevalence of and risk factors for fatty liver in a general population of Shanghai,China[J].J Hepatol,2005,43:508-514.
• [3]Lu HY,Zeng LY,Liang B,et al.High prevalence of coronary heart disease in type 2 diabetic patients with non-alcoholic fatty liver disease[J].Arch Med Res,2009,40:571-575.
• [4]周健,贾伟平,包玉倩,等.2型糖尿病患者脂肪肝患病率调查及危险因素分析[J].中华医学杂志,2007,87:2249-2252.
• [5]Sung KC,Ryan MC,Wilson AM.The severity of nonalcoholic fatty liver disease is associated with increased cardiovascular risk in a large cohort of non-obese Asian subjects[J].Atherosclerosis,2009,203:581-586.
• [6]Stefan N,Kantartzis K,Hring HU.Causes and metabolic consequences of fatty liver[J].Endocr Rev,2008,29:939-960.
• [7]Younossi ZM,Gramlich T,Matteoni CA,et al.Nonalcoholic fatty liver disease in patients with type 2 diabetes[J].Clin Gastroenterol Hepatol,2004,2:262-265.
• [8]El-Serag HB,Tran T,Everhart JE.Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma[J].Gastroenterology,2004,126:460-468.
• [9]Yang W,Lu J,Weng J,et al.Prevalence of diabetes among men and women in China[J].N Engl J Med,2010,362:1090-1101.
• [10]Xia MF,Yan HM,He WY,et al.Standardized ultrasound hepatic/renal ratio and hepatic attenuation rate to quantify liver fat content:an improvement method[J].Obesity,2012,20:444-452.
• [11]Ratziu V,Charlotte F,Heurtier A,et al.Sampling variability of liver biopsy in nonalcoholic fatty liver disease[J].Gastroenterology,2005,128:1898-1906.
• [12]Zelber-Sagi S,Webb M,Assy N,et al.Comparison of fatty liver index with noninvasive methods for steatosis detection and quantification[J].World J Gastroenterol,2013,19:57-64.
• [13]Strauss S,Gavish E,Gottlieb P,et al.Interobserver and intraobserver variability in the sonographic assessment of fatty liver[J].AJR Am J Roentgenol,2007,189:W320-W323.
• [14]Dasarathy S,Dasarathy J,Khiyami A,et al.Validity of real time ultrasound in the diagnosis of hepatic steatosis:a prospective study[J].J Hepatol,2009,51:1061-1067.
• [15]Webb M,Yeshua H,Zelber-Sagi S,et al.Diagnostic value of a computerized hepatorenal index for sonographic quantification of liver steatosis[J].AJR Am J Roentgenol,2009,192:909-914.
• [16]Borges VF,Diniz AL,Cotrim HP,et al.Sonographic hepatorenal ratio:a noninvasive method to diagnose nonalcoholic steatosis[J].J Clin Ultrasound,2013,41:18-25.
• [17]Kwon HJ,Kim KW,Lee SJ,et al.Value of the ultrasound attenuation index for noninvasive quantitative estimation of hepatic steatosis[J].J Ultrasound Med,2013,32:229-235.
• [18]Thijssen JM,Starke A,Weijers G,et al.Computer-aided b-mode ultrasound diagnosis of hepatic steatosis:a feasibility study[J].IEEE Trans Ultrason Ferroelectr Freq Control,2008,55:1343-1354.
• [19]温赐祥,廖桂英,刘锋.脂肪肝的超声诊断与血脂浓度相关性分析[J].现代医用影像学,2005,14:122-124.
• [20]刘明涛,刘增权,陈万宁,等.脂肪肝与血脂浓度的相关性分析[J].重庆医学,2009,38:466-467.
• [21]Lv WS,Sun RX,Gao YY,et al.Nonalcoholic fatty liver disease and microvascular complications in type 2 diabetes[J].World J Gastroenterol,2013,19:3134-3142.
• [22]Assy N,Kaita K,Mymin D,et al.Fatty infiltration of liver in hyperlipidemic patients[J].Dig Dis Sci,2000,45:1929-1934.
• [23]Angelico F,Del Ben M,Conti R,et al.Non-alcoholic fatty liver syndrome:a hepatic consequence of common metabolic diseases[J].J Gastroenterol Hepatol,2003,18:588-594.