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

  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。

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

  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.