肝硬度检测对慢性乙型病毒性肝炎合并非酒精性脂肪性肝病患者肝纤维化程度的准确性分析

Analysis of the accuracy of liver stiffness test on the degree of liver fibrosis in patients with chronic hepatitis B virus combined with non-alcoholic fatty liver disease

目的 肝脏脂肪变性会削弱肝硬度测定(liver stiffness measurement, LSM)的诊断效能,本研究旨在探索慢性乙型病毒性肝炎(chronic hepatitis B virus,CHB)合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)对于LSM诊断效能的影响,并分析相关影响因素。方法 研究选取2014年3月至2017年12月期间于天津市第三中心医院行FibroTouch检查的门诊及住院慢性乙型病毒性肝炎752例,其中CHB合并NAFLD患者246例纳入NALFD组,单纯CHB患者506例纳入非NAFLD组。通过数据统计分析比较NAFLD组及非NAFLD组一般资料和化验结果的差异,通过单因素及多因素线性回归探索影响LSM的因素。结果 NAFLD组与非NAFLD组的体质指数(body mass index,BMI)、受控衰减参数(controlled attenuation parameter,CAP)及LSM值存在显著差异。NAFLD组BMI高于非NAFLD组(P <0.001);NAFLD组CAP值高于非NAFLD组(P <0.001);NAFLD组LSM值高于非NAFLD组(P <0.001)。此外,NAFLD组血清血红蛋白(hemoglobin,Hb)、血小板(platelet,PLT)、白蛋白(albumin,ALB),丙氨酸转氨酶(alanine transaminase,ALT)、谷氨酰转肽酶(γ-glutamyl transpeptidase,γ-GT)、碱性磷酸酶(alkaline phosphatase,ALP)、葡萄糖(glucose,Glu)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、肌酐(creatinine,Cr)、尿素氮(blood urea nitrogen,BUN)及脾脏厚度(spleen thickness,SPT)均显著高于非NAFLD组(P <0.05)。NAFLD组男性患者比例高于非NAFLD组(分别为71.5%、54%,P <0.001)。多因素回归分析结果显示性别(男性)(B=0.004,P <0.120)、CAP(B=0.098,P <0.001)、ALB(B=-0.265,P <0.001)、γ-GT(B=0.128,P <0.001)、ALP(B=0.090,P=0.001)、ALT(B=0.124,P=0.004)与LSM呈显著相关。按性别分层,结果显示在不同性别中NAFLD组的BMI、CAP及LSM值均显著高于非NAFLD组(P <0.001)。结论 合并NAFLD的慢性乙型病毒性肝炎患者行肝硬度检查时,所得LSM值较单纯慢性乙型病毒性肝炎患者偏高,故合并NAFLD会影响慢性乙型病毒肝炎患者LSM的诊断效能,可能导致对患者实际肝纤维化程度的高估。

Objective The impact of hepatic steatosis on the diagnostic capability of liver stiffness measurement(LSM)has not been completely investigated. Therefore,we aimed at exploring the association between the existence of non-alcoholic fatty liver disease(NAFLD)and the diagnostic performance of LSM among patients with chronic hepatitis B virus(CHB)in a single center. Methods A total number of 752 patients with CHB from outpatients and inpatients who underwent Fibro Touch examination in Tianjin Third Central Hospital from March 2014 to December 2017 were included in this study. A total number of 506 patients with CHB alone were included in the non-NAFLD group,and 246 patients with CHB combined with NAFLD were included in the NALFD group. Results There were significant differences in BMI, CAP and LSM between the NAFLD group and non-NAFLD group. BMI were higher in NAFLD group than in non-NAFLD group(P < 0.001). CAP were higher in NAFLD group than in non-NAFLD group(P < 0.001). LSM were higher in NAFLD group than in non-NAFLD group(P < 0.001). Besides,the patients in NAFLD group had remarkably higher serum Hb, PLT, ALB, ALT, γ-GT, AST, Glu, TC, TG, TB, BUN, Cr, SPT levels than those without NAFLD. More male subjects were in NAFLD group than non-NAFLD group(P < 0.001).Multivariate linear regression analysis showed that gender(male)(B = 0.004,P < 0.120)、 CAP(B = 0.098, P < 0.001), ALB(B =-0.265, P < 0.001), γ-GT(B = 0.128, P < 0.001), ALP(B = 0.090, P = 0.001), ALT(B = 0.124, P = 0.004) were positively correlated with LSM. Stratified analysis by gender showed higher BMI, CAP and LSM in NAFLD group than in non-NAFLD group in both genders(P < 0.001). Conclusion LSM is higher in CHB patients with NAFLD, which could lead to an overestimation of fibrosis in those patients.