化学位移 MRI 对初诊2型糖尿病患者肝脏脂肪沉积的量化研究?

目的：探讨初诊2型糖尿病（T2DM）患者肝脏脂肪含量变化及相关因素。方法：收集初诊的 T2DM 患者（观察组）69例（女性16人，男性53人，平均年龄为（44.4±12.9）岁）及身体健康者（对照组）32例（女性15人，男性17人，平均年龄为（42.7±9.6）岁）。采用化学位移磁共振同、反相位成像技术分别测量肝脏各段的脂肪含量，比较两组间肝脏脂肪含量及 T2DM组肝脏各段的脂肪含量差异；分析 T2DM 组肝脏脂肪含量与体重、身体质量指数、腰围、臀围、腰臀比、腹壁皮下脂肪含量、腹腔脂肪含量、空腹血糖、空腹胰岛素、空腹 C 肽、血中总胆固醇、甘油三酯、高密度脂蛋白及低密度脂蛋白的相关性。结果：T2DM 组及健康对照组肝脏平均脂肪分数分别为19.55％±3.95％及15.74％±2.94％，差异有统计学意义（t =5.402，P <0.05）。T2DM 组肝脏Ⅰ至Ⅷ段的脂肪分数分别为18.67％±5.28％、19.52％±4.22％、19.37％±4.81％、19.63％±3.67％、19.39％±4.15％、19.44％±4.18％、19.67％±4.50％和20.43％±4.38％，各段的脂肪分数差异没有统计学意义（F =0.800，P >0.05）；T2DM 组肝脏平均脂肪分数与体重（r =0.316）、身体质量指数（r =0.302）、腰围（r =0.291）、臀围（r =0.279）、腹壁皮下脂肪含量（r =0.310）、空腹胰岛素（r =0.265）及空腹 C 肽（r =0.268）呈正相关（P <0.05），而与腰臀比（r =0.195）、腹腔脂肪含量（r =0.117）、空腹血糖（r =-0.039）、血中总胆固醇（r =-0.146）、甘油三酯（r =0.240）、高密度脂蛋白（r =0.012）及低密度脂蛋白（r =-0.137）没有相关性（P >0.05）。结论：初诊 T2DM 组的肝脏脂肪含量高于健康对照组，并且与体重、身体质量指数、腰围、臀围、腹壁皮下脂肪含量、空腹胰岛素及空腹 C 肽呈正相关。

Study of Liver Fat Content in Patients with Newly-diagnosed Type 2 Diabetes Mellitus on Chemical Shift MRI

Objective: To explore liver fat content and correlative factors in patients with newly-diagnosed type 2 diabetes mellitus (T2DM). Methods: Data were obtained from 69 patients with T2DM (16 females, 53 males; aged 44.4 ±12.9 years old) and 32 healthy volunteers (15 females, 17 males; aged 42.7 ±9.6 years old). The technique of double-echo chemical shift gradient-echo magnetic resonance imaging was used to measure the fat content of each hepatic segment respectively. The fat fraction between two groups and among hepatic segments was compared, and its correlation with body weight, body mass index, waistline, hipline, waist hip ratio, visceral adiposity, superficial adiposity, fasting blood glucose, fasting insulin, fasting c-peptide, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein was analyzed. Results: There were significant differences in the fat fraction between healthy volunteers and T2DM group (t = 5.402, P < 0.05). The fat fraction of hepatic segment Ⅰ to Ⅷ in T2DM patients was 18.67% ±5.28%, 19.52% ±4.22%, 19.37% ±4.81%, 19.63% ±3.67%, 19.39% ±4.15%, 19.44% ±4.18%, 19.67% ±4.50% and 20.43% ±4.38%, respectively, there was no significant difference among them (F = 0.800, P > 0.05); the body weight (r = 0.316), body mass index (r = 0.302), waistline (r = 0.291), hipline (r = 0.279), superficial adiposity (r = 0.310), fasting insulin (r = 0.265) and fasting c-peptide (r = 0.268) are positive correlation (P < 0.05) to the liver fat fraction, whereas the waist hip ratio (r = 0.195), visceral adiposity (r = 0.117), fasting blood glucose (r = -0.039), total cholesterol (r = -0.146), triglyceride (r = 0.240), high density lipoprotein (r = 0.012) and low density lipoprotein (r = -0.137) are irrelevant (P > 0.05) to the liver fat fraction. Conclusions: The liver fat content in newly-diagnosed patients with T2DM is higher than that in healthy people, and is positive correlation to the body weight, body mass index, waistline, hipline, superficial adiposity, fasting insulin and fasting c-peptide.