陈松 吴奇新 黄泽和 陈立坚 李敏 李伟雄

【摘要】 目的：探討非酒精性脂肪肝病双源CT表现与血脂水平的相关性。方法：选取笔者所在医院2017年1月-2019年8月收治的200例非酒精性脂肪肝病患者作为脂肪肝组，另选取同期体检的正常人员60例作为参考组，两组分别行双源CT检查，测量肝/脾CT值、肝脏脂肪含量;同时行血脂分析，检测甘油三酯（TG）、总胆固醇（CHOL）、血清低密度脂蛋白（LDL）、血清高密度脂蛋白（HDL）、血清载脂蛋白AI、血清载脂蛋白B;分析CT值、肝脏脂肪含量与血脂水平的相关性。结果：脂肪肝组肝/脾CT值（0.74±0.21）HU，低于参考组的（1.21±0.15）HU，肝脏脂肪含量（28.46±8.96）%，高于参考组的（9.54±3.02）%，差异有统计学意义（P<0.05）。脂肪肝组TG、CHOL、LDL、血清载脂蛋白AI、血清载脂蛋白B均高于参考组，HDL水平低于参考组（P<0.05）。重度脂肪肝组肝/脾CT值低于中、轻度组，肝脏脂肪含量、TG、CHOL、LDL、血清载脂蛋白AI、血清载脂蛋白B均高于中、轻度组，HDL水平低于中、轻度组（P<0.05），中度脂肪肝组与轻度组的双源CT表现及血脂水平比较，差异有统计学意义（P<0.05）。肝/脾比值与TG、CHOL、LDL、血清载脂蛋白AI、血清载脂蛋白B水平呈负相关，与HDL呈正相关;肝脏脂肪含量与TG、CHOL、LDL、血清载脂蛋白AI、血清载脂蛋白B水平呈正相关，与HDL呈负相关。结论：非酒精性脂肪肝病患者双源CT表现与血脂水平关系密切，血脂水平会影响肝/脾CT值，结合双能量脂肪定量技术可判定脂肪肝的浸润程度，值得临床推广。

【关键词】 非酒精性脂肪肝病 双源CT 血脂分析 相关性

doi：10.14033/j.cnki.cfmr.2020.20.020 文献标识码 B 文章编号 1674-6805（2020）20-00-03

Correlation between Dual Source CT Findings and Blood Lipid Levels in Nonalcoholic Fatty Liver Disease/CHEN Song， WU Qixin， HUANG Zehe， CHEN Lijian， LI Min， LI Weixiong. //Chinese and Foreign Medical Research， 2020， 18（20）： -54

[Abstract] Objective： To investigate the correlation between the dual source CT findings of non-alcoholic fatty liver disease and blood lipid level. Method： A total of 200 patients with nonalcoholic fatty liver disease admitted to our hospital from January 2017 to August 2019 were selected as the fatty liver group， and 60 normal persons in the same period were selected as the reference group. The two groups were examined by dual source CT respectively to measure the CT value of liver/spleen and the fat content of liver; at the same time， blood lipid analysis was carried out to detect the total cholesterol （CHOL） of triglyceride （TG） and serum low-density fat egg LDL， HDL， AI and B， and the correlation between CT value， liver fat content and blood lipid level was analyzed. Result： The CT value of liver/spleen in the fatty liver group was （0.74±0.21） HU， which was lower than （1.21±0.15） HU in the reference group， and the content of liver fat was （28.46±8.96）%， which was higher than （9.54±3.02）% in the reference group， the differences were statistically significant （P<0.05）. TG， CHOL， LDL， apolipoprotein AI and apolipoprotein B in the fatty liver group were higher than those in the reference group， and HDL level was lower than that in the reference group （P<0.05）. The CT value of liver/spleen in the severe fatty liver group was lower than that in the moderate and mild group， the content of liver fat， TG， CHOL， LDL， serum apolipoprotein AI， serum apolipoprotein B were higher than those in the moderate and mild group， the level of HDL was lower than that in the moderate and mild group （P<0.05）. Comparison of dual source CT findings and blood lipid levels between moderate fatty liver group and mild group were significant differences （P<0.05）. Liver/spleen ratio was negatively correlated with TG， CHOL， LDL， serum apolipoprotein AI and serum apolipoprotein B， and positively correlated with HDL; liver fat content was positively correlated with TG， CHOL， LDL， serum apolipoprotein AI and serum apolipoprotein B， and negatively correlated with HDL. Conclusion： The dual source CT findings of patients with nonalcoholic fatty liver disease are closely related to the blood lipid level， which will affect the CT value of liver/spleen. Combined with the dual energy fat quantitative technique， the degree of fatty liver infiltration can be determined， which is worthy of clinical promotion.

[Key words] Nonalcoholic fatty liver disease Dual source CT Lipid analysis Correlation

First-authors address： The First Peoples Hospital of Qinzhou， Qinzhou 535000， China

脂肪肝是我国常见的肝脏性疾病，是指肝脏内脂肪含量超过肝脏湿质量的5%以上。脂肪肝属于一种可逆性疾病，早期诊治可恢复正常，但诊治不及时甚至会发展为非酒精性脂肪肝、肝硬化及肝衰竭等，危及患者生命安全[1]。非酒精性脂肪肝是全球范围内流行的慢性肝病，并逐渐趋于年轻化，肝脏活组织检查是其金标准，但具有一定创伤性，腹部CT是检测脂肪肝的常用方法，以肝/脾CT值比值法作为常用指标，并与肝脏病理学分期结果相关性较高，其效果有大量资料肯定[2-3]。但CT成像参数改变及肝脏病理变化，会影响肝脏CT值[4]。自双源CT的应用，使用两组不同的管电压行双能量扫描，可精确鉴别骨、脂肪及软组织，获得物质分离图像[5]。因此，本研究就探讨非酒精性脂肪肝病双源CT表现与血脂水平的相关性，对肝/脾CT值、肝脏脂肪含量与血脂进行相关性分析，报道如下。……