4因子的纤维化指数联合肝脏硬度值对非酒精性脂肪性肝病肝纤维化的预测价值分析

The predictive value of FIB-4 index combined with liver stiffness measurement for liver fibrosis of non-alcoholic fatty liver disease

目的探讨基于4因子的纤维化(FIB-4)指数联合肝脏硬度值(LSM)对非酒精性脂肪性肝病(NAFLD)肝纤维化的预测价值。方法我院收治的NAFLD患者118例,根据肝纤维化评分(NFS)将患者分为轻度肝纤维化组(NFS<0.676, n =67)和严重纤维化组(NFS>0.676, n =51)。测量患者的LSM水平,计算FIB-4指数,分析FIB-4指数、LSM与NAFLD肝纤维化严重程度的相关性;评估LSM、FIB-4指数及二者联合对NAFLD肝纤维化的预测价值。结果轻度肝纤维化组LSM和FIB-4指数均小于重度肝纤维化组( P <0.05);LSM、FIB-4指数与肝纤维化分期均呈正相关,且LSM与肝纤维化分期的相关性高于FIB-4指数;ROC曲线分析结果显示,LSM、FIB-4指数及二者联合对NAFLD患者重度肝纤维化均有预测价值,ROC曲线下面积(AUC)分别为0.746、0.713和0.853( P <0.05),二者联合应用可提高诊断的敏感度和特异度。结论LSM、FIB-4指数与NAFLD肝纤维化分期呈正相关,均可对NAFLD患者的肝纤维化发展进行有效预测,可作为诊断NAFLD肝纤维化的参考指标,FIB-4指数联合LSM可提高诊断的敏感度和特异度。

Objective To explore the predictive value of fibrosis index based on the four factors(FIB-4)combined with liver stiffness measurement(LSM)in liver fibrosis of non-alcoholic fatty liver disease(NAFLD).Methods A total of 118 NAFLD patients who were admitted to our hospital were enrolled.According to the NAFLD fibrosis score(NFS),they were divided into mild liver fibrosis group(NFS<0.676,n=67)and severe liver fibrosis group(NFS>0.676,n=51).LSM level was measured,and FIB-4 index was calculated.The correlation between FIB-4 index,LSM and severity of liver fibrosis in NAFLD was analyzed.The predictive value of LSM,FIB-4 index and their combination for liver fibrosis of NAFLD was evaluated.Results LSM and FIB-4 index in the mild liver fibrosis group were lower than those in the severe liver fibrosis group(P<0.05).The results of correlation analysis showed that LSM and FIB-4 index were positively correlated with liver fibrosis stage(P<0.05)and the correlation between LSM and liver fibrosis stage was higher than that between FIB-4 index and liver fibrosis stage.The results of ROC curve analysis showed that LSM,FIB-4 index and FIB-4 index combined with LSM had a predictive value for severe liver fibrosis in NAFLD patients.Their areas under the ROC curve(AUC)values were 0.746,0.713 and 0.853,respectively(P<0.05).The combination application of FIB-4 index and LSM could improve the diagnostic sensitivity and specificity.Conclusion LSM and FIB-4 index are positively correlated with liver fibrosis stage of NAFLD,which can effectively predict the development of liver fibrosis,and can be applied as reference indexes for liver fibrosis diagnosis.The combination of FIB-4 index and LSM can improve the diagnostic sensitivity and specificity.