利用定量超音波評估非酒精性脂肪肝與第2型糖尿病的關係

中文摘要隨著科技與生活品質的日益提升，現代人時常因不良的飲食及生活習慣，致使非酒精性脂肪肝病與糖尿病的雙向影響浮現於大眾之中。糖尿病與脂肪肝(Fatty Liver Disease，FLD)的並存，容易有更高機率促使肝臟發炎並趨向肝癌的形成，相關的致死疾病也將隨之發生。脂肪肝的初步診斷於臨床上能透過超音波進行檢查，但糖尿病的影響與否是無法僅依靠肉眼觀察而做出判別。為了能盡早干預並建立一個客觀的辨別方法，定量超音波的應用就顯得十分重要。本研究收錄119位受試者，並使用超音波脂肪肝指標(Ultrasonographic Fatty Liver Indicator)將其中的84位分組成輕度脂肪肝(Mild FLD)和中重度脂肪肝(Severe FLD)，隨後兩組再依照有無糖尿病的伴隨進行細分。由紋理特徵參數、Nakagami參數及夏農熵(Shannon entropy)三種定量超音波參數對肝臟組織結構與影像特徵的不同解釋進行數據分析，並觀察糖尿病作用於脂肪肝受試者後的參數值差異，以供後續診斷效能的評估。藉由研究結果顯示，早期脂肪肝的病程若出現糖尿病的介入，聲學變化會比單純脂肪肝嚴重，從三種定量參數值皆可觀察到顯著的上升(P < 0.001)；反觀後期階段的脂肪肝病患，伴隨糖尿病影響的定量參數值也有所提升，不過各參數值分佈較為相似(P < 0.05)，說明糖尿病會以不明顯的方式驅使著脂肪肝的進行。同樣的趨勢也出現在紋理特徵的相關性分析，隨著脂肪變性越加強烈，與血糖生化值的相關性略為下降，不過仍然與脂肪肝有著中度的相關性(P < 0.001)。定量超音波的使用明確地幫助我們釐清非酒精性脂肪肝與糖尿病的連結，其評估結果足以描述臨床影像上無法提供的資訊，並且能提醒確診病患應注意血糖調控及規律作息的重要性，後續若能增加偵測範圍及評估參數，一定能使定量超音波有更佳的診斷效能，也能提高操作上的泛用性。

AbstractWith the continuous improvement of technology and quality of life, modern lifestyles often lead to the bidirectional impact of non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus becoming more prevalent. The coexistence of diabetes and fatty liver increases the likelihood of liver inflammation and progression toward liver cancer, with associated fatal diseases occurring as a result. Fatty liver can initially be diagnosed clinically through ultrasound examination. However, the influence of diabetes cannot be solely determined by visual observation. Therefore, the application of quantitative ultrasound is crucial for early intervention and establishing an objective differentiation method. This study included 119 participants, using the Ultrasonographic Fatty Liver Indicator to categorize 84 into Mild FLD and Severe FLD groups, further subdivided by the presence of diabetes. Data analysis was conducted on texture feature parameters, Nakagami parameters, and Shannon entropy, examining their different interpretations of liver tissue structure and imaging characteristics. The study observed parameter value differences in NAFLD subjects after the intervention of diabetes for subsequent diagnostic efficacy evaluation. The results showed that early-stage fatty liver with diabetes intervention exhibited more severe acoustic changes, with all three quantitative parameters significantly increasing (P < 0.001). In contrast, later-stage fatty liver patients with diabetes showed increased quantitative parameter values, but with a more similar distribution (P < 0.05), indicating that diabetes subtly drives the progression of fatty liver. A similar trend was observed in the correlation analysis of texture features; as fatty degeneration intensified, the correlation with blood glucose biochemical values slightly decreased, yet still maintained a moderate correlation with fatty liver (P < 0.001). The use of quantitative ultrasound has clearly helped clarify the link between NAFLD and diabetes. Its assessment results provide information not available from clinical imaging and remind diagnosed patients of the importance of blood sugar regulation and regular routines. With an expanded detection range and assessment parameters, quantitative ultrasound could achieve better diagnostic efficacy and broader applicability.