目的：本研究采用超声和双能CT技术对自发性恒河猴非酒精性脂肪性脂肪肝进行诊断，并与病理结果进行比较，探讨超声和双能CT在脂肪肝诊断中的价值。材料与方法：对70只雄性恒河猴（年龄7~20岁，体质量＞7 kg，乙肝和丙肝病毒呈阴性）进行超声检查，选取其中轻度脂肪肝、中度脂肪肝及部分正常动物进行双能CT检查。在双能CT检查之后1周对部分动物进行超声引导的肝脏穿刺活检。进行肝组织病理检查。结果：19例中度脂肪肝，12例轻度脂肪肝和正常恒河猴HU100 kVp/Sn140 kVp，ΔHUSn140-100 kVp和ΔHULv-Sp（50 keV）分别为0.95±0.04，（2.8±2.1） HU，（-16.4±6.3） HU；1.02±0.03，（-0.7±1.3） HU，（-6.8±5.0） HU和1.11±0.01，（-6.2±0.4） HU，（7.5±1.8） HU。各组之间差异均有显著意义（P<0.001）。与组织病理学结果相关性分析具有较好的相关性（R=-0.57，P<0.01；R=0.54，P<0.01；R=-0.71，P<0.001）。结论：双能CT与病理结果具有很高的一致性，双能CT作为非侵入性检查手段，对脂肪肝的定量具有较高的临床价值。
Abstract
Objective: To evaluate dual energy CT(DECT) diagnostic ability on nonalcoholic fatty liver disease/steatohepatitis(NAFLD/NASH), by comparing the DECT results with histopathology. Materials and Methods: Seventy Rhesus monkeys(Age >7 years, BW >7 kg, HBV and HCV negative) underwent ultrasound examination, among them 19 monkeys with moderate steatosis and 12 with mild steatosis and 6 normal monkeys took DECT examination, and within two weeks after DECT, ultrasound guided biopsy was done on 10 moderate and 8 mild steatosis and 6 normal monkeys. Results: HU100 kVp/Sn140 kVp, ΔHUSn140-100 kVp and ΔHULv-Sp（50 keV） were 0.95±0.04, (2.8±2.1) HU, (-16.4±6.3) HU; 1.02±0.03, (-0.7±1.3) HU, (-6.8±5.0) HU and 1.11±0.01, (-6.2±0.4) HU, (7.5±1.8) HU respectively. These results showed strong correlation with histopathology(R=-0.57, P<0.01; R=0.54, P<0.01; R=-0.71, P<0.001). Conclusion: The diagnostic results of DECT and the pathological results have a good consistency. As a noninvasive method, DECT showed great capacity on NAFLD diagnosis.
关键词
脂肪肝 /
猴疾病 /
体层摄影术 /
X线计算机 /
超声检查
Key words
Fatty liver /
Monkey diseases /
Tomography, X-ray computed /
Ultrasonography
中图分类号：
Ｒ575.5
R814.42
Ｒ445.1
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]LaBrecque DR, Abbas Z, Anania F, et al. World Gastroenterology Organisation global guidelines: nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[J]. Clin Gastroenterol, 2014, 48(9): 467-473.
[2]Bril F, Ortiz-Lopez C, Lomonaco R, et al. Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients[J]. Liver International, 2015, 35(9): 2139-2146.
[3]Li JH, Tsai CY, Huang HM. Assessment of hepatic fatty infiltration using dual-energy computed tomography: a phantom study[J]. Physiol Measurement, 2014, 35(4): 597.
[4]Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease[J]. Gastroenterology, 2002, 123(3): 745-750.
[5]Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease[J]. Hepatology, 2005, 41(6): 1313-1321.
[6]Zheng X, Ren Y, Phillips WT, et al. Assessment of hepatic fatty infiltration using spectral computed tomography imaging: a pilot study[J]. Comput Assist Tomogr, 2013, 37(2): 134-141.
[7]Kleiner DE, Makhlouf HR. Histology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in adults and children[J]. Clin Liver Dis, 2016, 20(2): 293-312.
[8]Bray GA, York DA. Hypothalamic and genetic obesity in experimental animals: an autonomic and endocrine hypothesis[J]. Physiol Rev, 1979, 59(3): 719-809.
[9]Leclercq IA, Farrell GC, Schriemer R, et al. Leptin is essential for the hepatic fibrogenic response to chronic liver injury[J]. J Hepatol, 2002, 37(2): 206-213.
[10]Ip E, Farrell G, Hall P, et al. Administration of the potent PPARα agonist, Wy-14, 643, reverses nutritional fibrosis and steatohepatitis in mice[J]. Hepatology, 2004, 39(5): 1286-1296.
[11]Larter CZ, Yeh MM, Williams J, et al. MCD-induced steatohepatitis is associated with hepatic adiponectin resistance and adipogenic transformation of hepatocytes[J]. J Hepatol, 2008, 49(3): 407-416.
[12]中华医学会肝脏病学会脂肪肝和酒精性肝病学组. 非酒精性脂肪肝病诊断标准[J]. 中华肝脏病杂志，2003，11（1）：71-72.
[13]Wang B, Gao Z, Zou Q, et al. Quantitative diagnosis of fatty liver with dual-energy CT[J]. Acta Radiologica, 2003, 44(1): 92-97.
[14]Hyodo T, Yada N, Hori M, et al. Multimaterial decomposition algorithm for the quantification of liver fat content by using fast-kilovolt-peak switching dual-energy CT: clinical evaluation[J]. Radiology, 2017, 283(1): 108-118.
基金
国家自然科学基金（81520108014，81528009）；四川省青年科技基金（编号：2015JQO059）；
四川省科技支撑计划（编号：2015SZ0012）；四川省科技服务业发展专项（编号：16FWSF0144）。
