The Correlation Analysis Of Quantifying The Degree Of Fatty Liver In Ultrasound

Objective:⑴Using ultrasound inspect the liver of the patients with fatty liver and the healthy, observed the characteristics of sonogram, and analysis the parameters such as liver echo strength , far-field dB values, the largest ramps drive of right lobe of liver,as well as the diameter, flow rate, the form of frequency spectrum of portal vein , hepatic vein and hepatic artery,then, investigate the value of judgement the extent of fatty liver and therapeutic efficacy.⑵Contrast with the pathology results, evaluation the reliability of quantifying the degree of fatty liver in ultrasound.Methods:⑴90 cases of fatty liver patients (excluding other liver diseases and heart ,lung and kidney disease, without pregnant women), divided into three groups(mild, moderate, severe) according to the extent of the echo of liver,the attenuation of far-field echo and the defining power of the blood vessel and bile duct in liver. Eight hours fasting subjects, supine or left lying position (right anterior oblique), the conventional two-dimensional surface to xiphoid, intercostal rib margin of scanning the liver, observation of the liver size, shape and internal echo, and record the largest diameter of oblique right lobe of the liver and the sensitivity shown by the cross-section of the far field dB value. Color Doppler flow imaging and pulsed Doppler detection portal vein and hepatic vein and hepatic artery diameter, flow rate and the spectrum shape. Detection of vascular requested detection angle of less than 60°, continuous detection from an average of three times. Choice 50 cases of healthy as control group matched the experimental group in age and gender, comparison of datas gathered from each group of fatty liver and the normal control group the differences between the various data. (2) All subjects caught eight hours fasting, and make a lipids and liver function blood tests before conducting ultrasonic testing, the test results out in the afternoon. (3) Fatty liver group of eight cases of varying degrees of fatty liver patients with liver biopsy, pathology organizations from the Second Hospital of Hebei Medical University Laboratory of Gastroenterology department and make pathological diagnosis.Application SPSS11.5 analysis software to analyze the results. A= 0.05 to a significant test for the standard.Results:1 Ultrasound examination results1.1 Far-field value of decibels (dB): With the increasing degree of fatty liver and far-field dB value increases. In the normal control group and mild fatty liver differences between the groups was not significant (P> 0.05). The remaining group had a significant difference (P <0.05). Far-field dB value and the degree of fatty liver disease correlated significantly(OR=1.562). Far-field dB value have a significantly correlated with the moderate and severe degree of fatty liver (in moderate B = 0.209, OR = 1.232, Wald = 6.886, P <0.01, in severe B = 0.446, OR = 1.562, Wald = 24.999, P <0.001).1.2 Right lobe of the liver largest oblique diameter (cm): With the increasing degree of fatty liver it increases. In the normal control group with severe fatty liver group, mild fatty liver and severe fatty liver group, the moderate group of fatty liver and severe group of fatty liver had a significant difference (P <0.05). Other groups to compare the difference was not significant (P> 0.05).1.3 Liver blood flow parameters of change1.3.1 Portal vein:With increasing severity, the portal vein diameter widened .In the normal control group, mild fatty liver group, the moderate group of fatty liver, severe fatty liver group in each group were significantly different (P <0.05); With the increasing severity of the fatty liver, the portal vein velocity descent;the control group and mild, moderate, severe fatty liver groups were significantly different (P <0.05). The normal group portal spectral band was continuous, with a slight respiratory ups and downs. Mild, moderate fatty liver group portal spectral differences with the normal group, severe fatty liver group portal-like spectrum shape was flat, without the ups and downs. 1.3.2 Hepatic vein: The left,the middle and the right hepatic vein diameter in the normal control group and mild, moderate, severe fatty liver group in each group there was no significant difference (P> 0.05); With the increasing severity of the fatty liver, the Hepatic venous velocity descent,(1) Tributary of the left hepatic vein velocity, in the normal group and the mild group, the normal group and the moderate group, the normal group and severe group, mild group and moderate groups, mild group and severe group were significantly different (P <0.05). Group of moderate and severe differences between the groups was not significant (P> 0.05); (2) Tributary of the middle hepatic venous flow in the normal group and the mild group, the normal group and the moderate group, the normal group and severe group, mild group and moderate groups, mild group and severe group had a significant difference (P <0.05), moderate group and severe differences between the groups was not significant (P> 0.05). Hepatic vein velocity had a significantly related with the group of moderate and severe fatty liver (medium B =- 0.212, OR = 0.809, Wald = 12.718, P <0.001, severe B =- 0.241, OR = 0.786, Wald = 15.081, P <0.001); (3) Tributary of the right hepatic vein velocity, in the normal group and the mild group, the normal group and the moderate group, the normal group and severe group, mild group and moderate groups, mild group and severe group had a significant difference (P <0.05), moderate group and severe differences between the groups was not significant (P> 0.05). Hepatic vein shape of the spectrum: Normal hepatic vein were HV0 spectral type, which accounts for 80 per cent of three-phase wave, the four-phase, 20 per cent ; Mild group: HV0 of 55%, HV1 of 45%;moderate group: HV0 of 36%, HV1 of 46%, HV2 of 18%; severe group: HV0 of 12%, HV1 of 38% , HV2 of 50% .The shape of normal hepatic vein was mainly baseline following negative phase of the spectrum, for the three-phase waveforms general, the minority for the four-phase type. Mild fatty liver group, for the spectral attenuation or normal-type, without flat shape, moderate and severe fatty liver groups hepatic veins spectral attenuation for more than type and flat.1.3.3 Hepatic artery:Hepatic artery diameter,there are no significant in the normal control group and mild, moderate, severe fatty liver (P> 0.05); With the increasing severity of the fatty liver, the velocity of systolic phase descent hepatic artery flow velocity in the normal group and the mild group, the normal group and the moderate group, the normal group and severe group, mild group and moderate groups, mild group and severe differences between the group, statistical significance ( P <0.05). There was no significant between the group of moderate and severe fatty liver (P> 0.05); There was no significant in the velocity of diastolic phase among the groups of fatty liver and the normal control group (P> 0.05); Hepatic arterial resistance index inherent in the normal group and the moderate group, the normal group and severe group, mild group and severe group, moderate group and the severe group had a significant difference (P <0.05) and the rest of the group there was no significant difference (P> 0.05).2 Indicators of liver function and blood lipid changes: Fatty Liver group ALT, AST andγ-GGT higher than the normal group, the group of fatty liver ALT are differences, there are significant difference(P <0.05),in the moderate and severe fatty liver AST is differences , there was significant difference(P <0.05).There are no difference among groups of fatty liver inγ-GGT. With the increasing degree of fatty liver disease, elevated blood lipids, and triglyceride (TG) increased even more obvious. Mild patients with fatty liver of high-density lipoprotein (HDL) increased significantly, severe fatty liver in patients with low-density lipoprotein (LDL) increased significantly.3 Pathological findings: Eight cases of fatty liver in patients with varying degrees of liver biopsy pathology examination, One case of fatty liver patients whose ultrasound diagnosis was moderate,whereas his pathological diagnosis is mild fatty liver, the other seven cases of fatty liver in patients whose ultrasound and pathological diagnosis was anastomosis, ultrasound diagnosis and pathology consistent with the rate of 87.5%. 4 90 cases of fatty liver patients, there are 8 percent of normal weight, 79 percent of overweight, 13 percent obese. Statistics shows that overweight and obese people with a larger proportion of fatty liver.Conclusion:1 There is a good correlation between the fatty liver patients'liver far-field decibels value and the middle hepatic vein velocity with moderate and severe fatty liver degree. If the far-field decibels value is more than 18.5dB, the sensitivity of diagnosis the moderate fatty liver is 85.2%, and specificity is 54.2%, If the far-field decibels value is more than 19.5dB, the sensitivity of diagnosis the severe fatty liver is 81.6%, and specificity is 96.6%.If the hepatic venous flow rate of less than 21.8 cm/s, the sensitivity of diagnosis the moderate fatty liver is 59.3%, and specificity is 82.1%,and when the hepatic venous flow rate of less than 18.1cm/s, the sensitivity of diagnosis the severe fatty liver is 72.8%, and specificity is 73.1%. Determination of these two parameters can be used as fatty liver ultrasound to quantify the specific points of reference.2 Patients in fatty liver with portal vein diameter widened, reducing velocity,the hepatic vein and the hepatic artery velocity reduced, hepatic artery resistance index increased, and so hemodynamic changes,can reflect the liver perfusion, to evaluate the extent of fatty liver, and an assessment of therapeutic effects.3 The right lobe of the liver largest oblique drive increased with the degree of fatty liver, and the differences between the groups were statistically significant, it can be used as points of reference for quantitative indicators in fatty liver of ultrasound.4 Hyperlipidemia is the relevant factors induced of fatty liver, overweight and obese people with higher risk of fatty liver.