血清酸性鞘磷脂酶联合FIB-4指数对非酒精性脂肪肝合并糖尿病患者早期肝纤维化预测价值

Predictive value of serum acid sphingomyelinase combined with FIB-4 index for early liver fibrosis in patients with non-alcoholic fatty liver complicated by diabetes

目的探讨血清酸性鞘磷脂酶(ASMase)联合肝纤维化指数(FIB-4)指数对非酒精性脂肪肝(NAFLD)合并糖尿病患者早期肝纤维化预测价值。方法选取2018年2月至2021年2月海南省屯昌县人民医院收治的126例NAFLD合并糖尿病患者,根据病理诊断分为早期肝纤维化组(n=74例)和无纤维化组(n=52例),比较2组患者临床特征以及血清ASMase水平和FIB-4指数。采用logistic回归分析影响NAFLD合并糖尿病患者早期肝纤维化的因素,采用受试者工作特征曲线(ROC)分析血清ASMase水平和FIB-4指数预测NAFLD合并糖尿病患者早期肝纤维化的价值。结果肝纤维化组患者血清ASMase水平和FIB-4指数分别为(58.49±9.15)nmol/L,(0.82±0.13),均高于无肝纤维化组的(44.06±7.63)nmol/L,(0.65±0.10),差异有统计学意义(P<0.05);单因素分析显示肝纤维化组患者性别、年龄、吸烟史、饮酒史、基础疾病构成比以及年龄、腰围、糖尿病病程、平均动脉压、血清血糖、尿素氮、尿酸、白蛋白、总胆红素、直接胆红素、谷氨酰转肽酶、ALt、AST、总胆固醇、三酰甘油、血小板、碱性磷酸酶构成比与无肝纤维化组比较,差异均无统计学意义(P>0.05);肝纤维化组体质指数(BMI)、血清碱性磷酸酶水平与无肝纤维化组比较,差异均有统计学意义(P<0.05);logistic多因素回归分析显示ASMase、FIB-4指数、BMI均是NAFLD合并糖尿病患者早期肝纤维化的独立危险因素(OR=3.031、3.501、3.114,P<0.05);ROC分析显示,血清ASMase水平和FIB-4指数预测NAFLD合并糖尿病患者早期肝纤维化的最佳截断点分别为50.73 nmol/L和0.68,灵敏度分别为83.78%和81.08%,特异度分别为71.15%和80.77%,曲线下面积(AUC)分别为0.854和0.838,二者联合的灵敏度、特异度和AUC分别为83.78%,98.08%和0.874。结论NAFLD合并糖尿病早期肝纤维患者血清ASMase水平和FIB-4指数均异常升高,二者均是NAFLD合并糖尿病早期肝纤维的独立危险因素,动态监测其水平变化可作为预测NAFLD合并糖尿病患者早期肝纤维的敏感指标。

Objective To explore the value of serum acid sphingomyelinase(ASMase)combined with liver fibrosis index(FIB-4)in predicting early liver fibrosis in non-alcoholic fatty liver(NAFLD)patients with diabetes.Methods 126 patients with NAFLD complicated by diabetes who were admitted to the hospital from February 2018 to February 2021 were selected and divided into the early liver fibrosis group(n=74 cases)and the non-fibrosis group(n=52 cases)according to the pathological diagnosis.The serum ASMase level and FIB-4 index of the two groups of patients were compared,the clinical characteristics of the two groups of patients were compared,Logistic regression analysis was used to determine the factors affecting early liver fibrosis in patients with NAFLD complicated by diabetes,the receiver operating characteristic curve(ROC)was used to analyze the value of serum ASMase level and FIB-4 index in predicting early liver fibrosis in patients with NAFLD complicated by diabetes.Results Serum ASMase level and FIB-4 index[(58.49±9.15)nmol/L,(0.82±0.13)]of patients with liver fibrosis were higher than those without liver fibrosis[(44.06±7.63)nmol/L,(0.65±0.10)](P<0.05).Univariate analysis showed that the gender,age,smoking history,drinking history,underlying disease composition,age,waist circumference,diabetes course,mean arterial pressure,serum blood glucose,urea nitrogen,uric acid,albumin,and total bilirubin of patients in the liver fibrosis group,Direct bilirubin,glutamyl aminotransferase,alanine aminotransferase,aspartate aminotransferase,total cholesterol,triglycerides,platelets,alkaline phosphatase composition ratio compared with the non-liver fibrosis group,the difference was not statistically significant(P>0.05).The body mass(BMI)and serum alkaline phosphatase levels of the liver fibrosis group were compared with those without liver fibrosis,and the differences were statistically significant(P<0.05),Logistic multivariate regression analysis showed that ASMase,FIB-4 index,and BMI were independent risk factors for early liver fibrosis in NAFLD patients with diabetes(OR=3.031,3.501,3.114,P<0.05).ROC analysis showed that the best cut-off points of serum ASMase level and FIB-4 index for predicting early liver fibrosis in NAFLD patients with diabetes were 50.73 nmol/L and 0.68,respectively,the sensitivity were 83.78%and 81.08%,and the specificity were 71.15%and 80.77%,respectively,and the area under the curve(AUC)were 0.854 and 0.838,respectively,the sensitivity,specificity and AUC of the combination of the two were 83.78%,98.08%and 0.874,respectively.Conclusion The serum ASMase level and FIB-4 index of patients with early liver fibrosis for NAFLD complicated by diabetes are abnormally increased,both are independent risk factors for early liver fiber in NAFLD complicated by diabetes,dynamic monitoring of its level changes can be used as the sensitive indicator to predict early liver fiber in patients with NAFLD complicated by diabetes.