留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

2型糖尿病患者脂肪肝超声定量评估与生化指标的相关性

韩洁 吕珂 李玉秀 王亮 戴晴 姜玉新 李曾一 周美岑

韩洁, 吕珂, 李玉秀, 王亮, 戴晴, 姜玉新, 李曾一, 周美岑. 2型糖尿病患者脂肪肝超声定量评估与生化指标的相关性[J]. 协和医学杂志, 2014, 5(1): 59-63. doi: 10.3969/j.issn.1674-9081.2014.01.014
引用本文: 韩洁, 吕珂, 李玉秀, 王亮, 戴晴, 姜玉新, 李曾一, 周美岑. 2型糖尿病患者脂肪肝超声定量评估与生化指标的相关性[J]. 协和医学杂志, 2014, 5(1): 59-63. doi: 10.3969/j.issn.1674-9081.2014.01.014
Jie HAN, Ke LÜ, Yu-xiu LI, Liang WANG, Qing DAI, Yu-xin JIANG, Zeng-yi LI, Mei-cen ZHOU. Sonographic Quantification of Non-alcoholic Fatty Liver in Patients with Type 2 Diabetes Mellitus and the Association of Its Findings with Biochemical Indicators[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(1): 59-63. doi: 10.3969/j.issn.1674-9081.2014.01.014
Citation: Jie HAN, Ke LÜ, Yu-xiu LI, Liang WANG, Qing DAI, Yu-xin JIANG, Zeng-yi LI, Mei-cen ZHOU. Sonographic Quantification of Non-alcoholic Fatty Liver in Patients with Type 2 Diabetes Mellitus and the Association of Its Findings with Biochemical Indicators[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(1): 59-63. doi: 10.3969/j.issn.1674-9081.2014.01.014

2型糖尿病患者脂肪肝超声定量评估与生化指标的相关性

doi: 10.3969/j.issn.1674-9081.2014.01.014
基金项目: 

国家自然科学基金 81270878

详细信息
    通讯作者:

    吕珂 电话:010-69155494, E-mail:lvke@163.com

  • 中图分类号: R445.1;R587.1

Sonographic Quantification of Non-alcoholic Fatty Liver in Patients with Type 2 Diabetes Mellitus and the Association of Its Findings with Biochemical Indicators

More Information
    Corresponding author: LÜ Ke Tel: 010-69155494, E-mail:lvke@163.com
  • 摘要:   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。
  • 图  1  超声肝右叶肋间切面(A)和肝-右肾矢状切面(B)分析示意图

    1~4分别代表肝脏近场感兴趣区、肝脏远场感兴趣区、肝内感兴趣区和肾内感兴趣区回声灰度直方图及灰阶强度;图A中6.01 cm为肝内近场和远场感兴趣区间直线距离

    表  1  不同组肝肾回声比值及肝脏回声衰减系数比较(x±s)

    分组 肝肾回声比值 肝脏回声衰减系数
    正常组 0.926±0.175 0.954±0.103
    轻度脂肪肝组 1.350±0.302* 1.206±0.198*
    中-重度脂肪肝组 1.628±0.829* 1.546±0.400*†
    与正常组比较,*P<0.05;与轻度脂肪肝组比较,P<0.05
    下载: 导出CSV

    表  2  不同组生化指标比较(x±s)

    分组 TG(mmol/L) TC(mmol/L) ALT(U/L) AST(U/L) GGT(U/L) UA(μmol/L) HbA1C(%)
    正常组 1.10±0.71 5.17±0.99 21.60±6.48 23.94±4.04 17.82±5.95 262.88±48.74 7.00±1.21
    轻度脂肪肝组 1.82±0.84* 4.80±0.83 30.31±17.95 23.62±8.04 21.58±9.44 290.60±65.39 6.78±0.82
    中-重度脂肪肝组 2.86±1.75*† 5.02±0.85 30.50±21.38 29.86±15.84 30.17±15.79* 361.25±80.49* 7.29±1.57
    TG:甘油三酯;TC:总胆固醇;ALT:丙氨酸转移酶;AST:天门冬氨酸转移酶;GGT:γ-谷氨酰转移酶;UA:尿酸;HbA1C:糖化血红蛋白;与正常组比较,*P<0.05;与轻度脂肪肝组比较,P<0.05
    下载: 导出CSV

    表  3  肝肾回声比值、肝脏回声衰减系数、生化指标与脂肪肝分度的相关性

    变量指标 相关系数 P
    肝肾回声比值 0.678 0.000
    肝脏回声衰减系数 0.788 0.000
    TG 0.609 0.000
    GGT 0.397 0.018
    UA 0.365 0.044
    TG、GGT、UA:同表 2
    下载: 导出CSV
  • [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. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhgzbzz200603001
    [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. doi:  10.1016/j.jhep.2005.02.042
    [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. doi:  10.1016/j.arcmed.2009.07.009
    [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. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyx200732006
    [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. doi:  10.1016/j.atherosclerosis.2008.07.024
    [6] Stefan N, Kantartzis K, Häring HU. Causes and metabolic consequences of fatty liver[J]. Endocr Rev, 2008, 29:939-960. doi:  10.1210/er.2008-0009
    [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. doi:  10.1016/S1542-3565(04)00014-X
    [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. doi:  10.1053/j.gastro.2003.10.065
    [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. doi:  10.1056/NEJMoa0908292
    [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. doi:  10.1038/oby.2011.302
    [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. doi:  10.1053/j.gastro.2005.03.084
    [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. doi:  10.3748/wjg.v19.i1.57
    [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. doi:  10.2214/AJR.07.2123
    [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. doi:  10.1016/j.jhep.2009.09.001
    [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. doi:  10.2214/AJR.07.4016
    [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. http://europepmc.org/abstract/med/22997020
    [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. doi:  10.7863/jum.2013.32.2.229
    [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. doi:  10.1109/TUFFC.2008.797
    [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. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xdyyyxx200503009
    [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. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=cqyx200904039
    [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. doi:  10.3748/wjg.v19.i20.3134
    [22] Assy N, Kaita K, Mymin D, et al. Fatty infiltration of liver in hyperlipidemic patients[J]. Dig Dis Sci, 2000, 45:1929-1934. doi:  10.1023/A:1005661516165
    [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. doi:  10.1046/j.1440-1746.2003.02958.x
  • 加载中
图(1) / 表(3)
计量
  • 文章访问数:  11
  • HTML全文浏览量:  2
  • PDF下载量:  3
  • 被引次数: 0
出版历程
  • 收稿日期:  2013-10-21
  • 刊出日期:  2014-01-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!