摘要
目的 比较不同无创方法对2型糖尿病(T2DM)伴非酒精性脂肪肝病(NAFLD)患者脂肪性肝炎(NASH)及肝纤维化NASH的诊断作用。 方法 前瞻性地比较91例经葡萄糖耐量试验明确诊断为T2DM、同时经肝穿刺活检诊断为NAFLD的患者,测量患者的身高、体质量,计算体质指数(BMI);采集患者的空腹静脉血,测定血常规及肝功能、铁蛋白。计算脂肪性肝炎预测评分(NPS)、中性粒细胞淋巴细胞比值(NLR)、BARD评分、FIB4指数、APRI及NAFLD纤维化评分(NFS),所有患者行瞬时弹性成像技术(Fibrotouch)检查,测量肝脏脂肪衰减指数及肝硬度。患者肝穿刺标本应用SAF判断作为评价NASH及肝纤维化NASH的金标准,采用相关性分析比较其余无创方法与SAF的相关性,用受试者工作特征(ROC)曲线及曲线下面积(AUC)判断各种无创方法对NASH及肝纤维化NASH的诊断价值。 结果 T2DM伴NAFLD的患者中,其NPS、LSM、NFS、APRI、FIB4、BMI与SAF评分呈正相关(r值分别为0.509、0.508、0.252、0.313、0.213,P值分别为<0.001、<0.001、0.016、<0.001、0.003、0.043),LSM、NPS、NFS、FIB4与肝纤维化分级呈正相关(r值分别为0.535、0.337、0.315及0.315,P值分别为<0.001、0.001、0.002、0.002)。ROC曲线显示NPS,LSM,APRI,FIB4,BMI诊断NASH的曲线下面积分别为0.838、0.760、0.734、0.623、0.682,P值分别为0.000、0.000、0.000、0.044和0.003,LSM、NFS、FIB4、NPS诊断纤维化NASH的曲线下面积分别为0.795、0.765、0.686、0.623,P值分别为0.000、0.001、0.020和0.123。 结论 NPS、LSM及APRI用于NASH均具有良好的临床诊断价值;LSM及NFS用于纤维化NASH具有良好的诊断价值。
Objective To evaluate the accuracy of different noninvasive methods for the diagnosis of nonalcoholic steatohepatitis(NASH) and hepatic fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus(T2DM). Method A prospective comparative study was performed for 91 patients with T2DM and NAFLD, which were diagnosed by glucose tolerance test and liver biopsy. The height and body mass of the patient were measured, and the body mass index(BMI) was calculated. The fasting venous blood of the patient was collected, and then the blood routine, liver function and ferritin were measured. NPS, neutrophil lymphocyte ratio(NLR), BARD score, FIB-4 index, APRI, and NAFLD fibrosis score(NFS) were calculated. All patients underwent transient elastography (Fibrotouch) to evaluate the degree of liver stiffness measurement (LSM) and controlled attenuation parameter. All the liver biopsy specimens were categorized by SAF as the gold standard for evaluating NASH and liver fibrosis NASH. Correlation analysis was applied to compare the correlation between the noninvasive methods and SAF. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to assess the diagnostic value of the noninvasive methods for NASH and liver fibrosis NASH. Results In T2DM combine with NAFLD patients, NPS, LSM, NFS, APRI, FIB4 and BMI scores were positively correlated with SAF(r value was 0.509, 0.508, 0.252, 0.396, 0.313 and 0.213, respectively; P value was <0.001, <0.001, 0.016, <0.001, 0.003 and 0.043, respectively). LSM, NPS, NFS and FIB4 scores were positively correlated with liver fibrosis (r value was 0.535, 0.337, 0.315 and 0.315, respectively; P value was <0.001, 0.001, 0.002, 0.002, respectively). The ROC curve shows that the area under the curve of NPS, LSM, APRI, FIB4 and BMI for diagnosing NASH was 0.838, 0.760, 0.734, 0.623 and 0.682, respectively, and P value was 0.000, 0.000, 0.000, 0.044 and 0.003, respectively. For the diagnosis of fibrotic NASH, that value of
作者
贾国瑜
韩涛
王璐
李强
王少程
管玥琰
闫娜娜
张勤
刘贵秋
邸阜生
Jia Guoyu;Hart Tao;Wang Lu;Li Qiang;Wang Shaocheng;GuanYueyan;Yon Nano;Zhang Qin;Liu Guiqiu;Di Fusheng(Department of Endocrinology and Metabolism, the third Central Clinical College of Tianjin Medical University, Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cells (TKL), Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China;Department of Hepatology, Third Central Hospital of Tianjin;Institute of Hepatobiliary Disease, Tianjin 300170, China;Department of Endocrinology and Metabolism, Third Central Hospital of Tianjin, Tianjin 300170, China)
出处
《国际生物医学工程杂志》
CAS
2018年第5期401-409,共9页
International Journal of Biomedical Engineering
基金
天津市卫生局科技基金资助项目(2014KY02).
关键词
2型糖尿病
非酒精性脂肪肝病
非酒精性脂肪性肝炎
肝纤维化
肝硬度
无创评分指标
Type 2 diabetes
Non-alcoholic fatty liver disease
Nonalcoholic steatohepatitis
Hepatic fibrosis
Liver stiffness
Noninvasive predictors
