肝脏硬度值及血清生化指标与非酒精性脂肪性肝炎的相关性分析

Association of liver stiffness measurement and serum biochemical parameters with nonalcoholic steatohepatitis

目的评估肝脏硬度值(LSM)及血清生化指标与非酒精性脂肪肝性肝炎(NASH)肝脏脂肪变、肝脏炎症、肝纤维化的相关性。方法选择2007年1月-2018年12月入住解放军总医院第五医学中心的NASH患者520例,依据BMI(界值为28 kg/m^2)分为肥胖组(n=151)和非肥胖组(n=369)。所有患者均接受肝组织病理学检查,肝活检前3 d内检测LSM,收集患者肝穿前的血清生化学指标及一般临床资料,计算血清学无创模型数据APRI、FIB-4。正态分布计量资料2组间比较采用t检验;非正态分布计量资料2组间比较采用两独立样本非参数Mann-Whitney U检验。计数资料2组间比较采用χ~2检验。相关性分析采用Spearman秩相关分析。结果随着BMI水平升高,ALT、AST、LSM、肝脏脂肪衰减参数、脾长、APRI逐渐升高,差异均有统计学意义(P值均<0.05)。Spearman相关分析显示LSM、ALT、BMI、CAP与肝脂肪变性程度呈正相关(r值分别为0.263、0.327、0.184、0.452,P值均<0.05;LSM、ALT、CAP与肝脏炎症程度呈正相关(r值分别为0.357、0.278、0.121,P值均<0.05);LSM、ALT、BMI、CAP与肝纤维化程度呈正相关(r值分别为0.500、0.216、0.248、0.101,P值均<0.05);年龄与肝脂肪变性程度、肝脏炎症程度、肝纤维化程度均呈负相关(r值分别为-0.344、-0.129、-0.163,P值均<0.05)。结论 LSM、CAP、ALT、年龄与NASH的肝脏炎症程度、肝纤维化程度、肝脂肪变性程度有明确的相关性,可作为临床评估肝脏损伤程度的指标被应用于无创诊断预测模型中。

Objective To investigate the association of liver stiffness measurement(LSM)and serum biochemical parameters with hepatic steatosis,liver inflammation,and liver fibrosis in patients with nonalcoholic steatohepatitis(NASH).Methods A total of 520 patients with NASH who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January 2007 to December 2018 were enrolled,and according to body mass index(BMI)with a cut-off value of 28 kg/m 2,the patients were divided into obese group with 151 patients and non-obese group with 369 patients.All patients underwent liver biopsy,and LSM was measured within 3 days before biopsy.Serum biochemical parameters and general clinical data were collected before liver biopsy,and the noninvasive indices aspartate aminotransferase to platelet ratio index(APRI)and fibrosis-4(FIB-4)were calculated.The t-test was used for comparison of normally distributed continuous between groups,the nonparametric Mann-Whitney U test was used for comparison of non-normally distributed continuous between groups;the chi-square test was used for comparison of categorical data between groups.A Spearman rank correlation analysis was also performed.Results Alanine aminotransferase(ALT),aspartate aminotransferase,LSM,controlled attenuation parameter(CAP),spleen length,and APRI gradually increased with the increase in BMI(all P<0.05).The Spearman correlation analysis showed that LSM,ALT,BMI,and CAP were positively correlated with the degree of hepatic steatosis(r=0.263,0.327,0.184,and 0.452,all P<0.05);LSM,ALT,and CAP were positively correlated with the degree of liver inflammation(r=0.357,0.278,and 0.121,all P<0.05);LSM,ALT,BMI,and CAP were positively correlated with the degree of liver fibrosis(r=0.500,0.216,0.248,and 0.101,all P<0.05);age was negatively correlated with the degree of hepatic steatosis,liver inflammation,and liver fibrosis(r=-0.344,-0.129,and-0.163,all P<0.05).Conclusion LSM,CAP,ALT,and age are significantly correlated with the degree of liver inflammation,liver fibrosis,and hepatic steatosis in NASH patients,and therefore,they can be used in noninvasive diagnostic and predictive models to access the severity of liver injury.