| Objective:To explore the value of ultrasonic echo intensity (EI) parameters in fatty liver quantitative diagnosis and classification by using echo intensity quantification technology analyzes El characteristics of fatty liver and contrasting diagnosis effect of EI parameter and biochemical indicator. Analysis the correlation between ultrasonic El and traditional Chinese medicine (TCM) syndromes of fatty liver in order to widen ultrasound research scope and find a new objective basis for fatty liver TCM diagnosis.Methods:200 fatty liver patients and 30 healthy people who were examined by ultrasound in China-Japan friendship hospital during January and September 2010 include in this study. Patients with fatty liver were divided into mild, moderate and severe groups according to traditional ultrasound method and healthy people acted as control (there are 80 patients in mild group,80 patients in moderate group and 40 patients in severe group). These subjects'liver EI characteristics were analyzed by Philips iU22 ultrasound diagnostic apparatus and QLab-ROI acoustic quantification analysis software, the position of right liver parenchyma from surface 1/6,1/3,1/2,2/3,5/6, middle pole of right kidney essence, left liver parenchyma from surface 1.5cm and upper pole of spleen were located as the ROI, the El curves were obtained after analysis. Import the result to Excel database to get the quantitative indicators, and then the relationships between indicators and fatty liver were analyzed.The 230 subjects'alanine aminotransferase (ALT), alkaline phosphatase (ALP),γ-glutamyl transferase (GGT), aspartate transfer Enzyme (AST) and glucose (GLU) value was measured with the Hitachi 7080 automatic biochemical analyzer. The relationships between the value and fatty liver were analyzed, and the effect of biochemical indicators and El to diagnose fatty liver was compared.By mainly observing the tongue,200 fatty liver patients were divided into syndrome of phlegmatic dampness accumulation, syndrome of liver depression and qi stagnation, syndrome of spleen deficiency and damp accumulation, syndrome of damp heat accumulation and syndrome of intermingled phlegm and blood stasis. according to the fatty liver TCM syndrome diagnostic criteria. The distribution of fatty liver TCM syndromes were analyzed, and the relationship between ultrasonic EI and TCM syndromes of fatty liver were studied. Result:1. EI of right liver parenchyma from surface 1/6, left liver, EI ratio of right liver parenchyma from surface 1/6 and 1/2,1/6 and 2/3,1/6 and 5/6,1/6 and right kidney are significant different in each two groups (P< 0.05), EI of right liver parenchyma from surface 2/3,5/6, EI ratio of right liver parenchyma from surface 5/6 and right kidney are significant different among severe fatty liver group and the control group, mild fatty liver group, moderate fatty liver group (P<0.05).2. ALT,GGT,AST/ALT values are significant different in each two groups (P< 0.05), ALP value is significant different between the control group and fatty liver groups.3. EI of right liver parenchyma from surface 1/6 is significantly correlated to the classification of fatty liver (correlation coefficient is 0.790, P=0.000), EI ratio of right liver parenchyma from surface 1/6 and 5/6 is highly correlated to the classification of fatty liver (correlation coefficient is0.801,P=0.000), ALT is lowly correlated to the classification of fatty liver (correlation coefficient is0.393, P=0.000). The areas under the fatty liver diagnosis ROC curves of EI of right liver parenchyma from surface 1/6, EI ratio of right liver parenchyma from surface 1/6 and 5/6, ALT are 0.990,0.946,0.774. The fatty liver diagnosis accuracy of EI of right liver parenchyma from surface 1/6 is higher than EI ratio of right liver parenchyma from surface 1/6 and 5/6 and ALT.4. In general, fatty liver syndromes mainly include syndrome of spleen deficiency and damp accumulation and syndrome of damp heat accumulation. Mild fatty liver were common in syndrome of liver depression and qi stagnation, moderate fatty liver were common in syndrome of spleen deficiency and damp accumulation, severe fatty liver were common in syndrome of damp heat accumulation and syndrome of phlegmatic dampness accumulation, and the mild fatty liver were also common in syndrome of intermingled phlegm and blood stasis. EI of right liver parenchyma from surface 1/6,1/3, EI ratio of right liver parenchyma from surface 1/6 and 1/2,1/6 and 2/3,1/6 and 5/6 of syndrome of phlegmatic dampness accumulation are higher than syndrome of spleen deficiency and damp accumulation (P< 0.05), EI of right liver parenchyma from surface 5/6 of syndrome of phlegmatic dampness accumulation is lower than syndrome of spleen deficiency and damp accumulation (P< 0.05). EI of right liver parenchyma from surface 1/6,1/3, EI ratio of right liver parenchyma from surface 1/6 and 5/6 are weakly correlated to the TCM syndromes of fatty liver (correlation coefficients are 0.152,0.143,0.141, P values are 0.033,0.048,0.050), and they are positive correlations.Conclusion:1. EI of liver, EI ratio of liver, spleen, right kidney can be used to diagnosis fatty liver objectively and quantitativly, it also can be used to distinguish the severity of fatty liver.2. The biochemical indicators are good reference to diagnosis and classification fatty liver.3. Ultrasonic EI was proved has higher value than biochemical indicators in fatty liver diagnosis, and EI of right liver parenchyma from surface 1/6 is the best indicator in fatty liver diagnosis, when it was 14.99dB, the fatty liver diagnosis sensitivity was 95%, specificity was 100%.4. There is a certain correlation between ultrasonic EI parameters and TCM syndromes of fatty liver, the ultrasonic El can be a new objective basis for Chinese medicino diagnosis. |
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